Abstract
The records of 700 patients with hand infections were reviewed. Forty- six (6%) had osteomyelitis of the metacarpals or phalangeal bones. The cause was post-traumatic in 57%, postoperative in 15%, hematogenous in 13%, spread from contiguous infections in 9%, and unidentified in 6%. Twenty-two percent of the patients had vascular insufficiency and/or were immunocompromised. History, physical exam, plain x-rays, and open biopsy and culture were most helpful in establishing the diagnosis. Laboratory studies and bone scans were less helpful. Cultures were positive in 74% of patients, with a noteworthy number of mixed infections (35%) and gram-positive infections (35%). Gram- negative infections accounted for 15%, fungal infections for 12%, and mycobacterial infections for 3%. Surgical management varied from simple curettage to more elaborate staged reconstructions and/or arthrodeses. Despite provision of aggressive surgical care and use of appropriate antibiotics, the overall amputation rate was 39% (18/46). A delay of more than 6 months from onset of symptoms to diagnosis and definitive treatment led to amputation in 6 of 7 patients (86%), 2 of whom had squamous-cell carcinoma. Of the 12 patients who underwent more than 3 surgical procedures, 8 ultimately underwent amputation and 2 had marked disability.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 644-649 |
| Number of pages | 6 |
| Journal | Journal of Hand Surgery |
| Volume | 22 |
| Issue number | 4 |
| DOIs | |
| State | Published - 1997 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Surgery
Cite this
Osteomyelitis of the tubular bones of the hand. / Reilly, K. E.; Linz, J. C.; Stern, P. J.; Giza, Eric; Wyrick, J. D.
In: Journal of Hand Surgery, Vol. 22, No. 4, 1997, p. 644-649.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Osteomyelitis of the tubular bones of the hand
AU - Reilly, K. E.
AU - Linz, J. C.
AU - Stern, P. J.
AU - Giza, Eric
AU - Wyrick, J. D.
PY - 1997
Y1 - 1997
N2 - The records of 700 patients with hand infections were reviewed. Forty- six (6%) had osteomyelitis of the metacarpals or phalangeal bones. The cause was post-traumatic in 57%, postoperative in 15%, hematogenous in 13%, spread from contiguous infections in 9%, and unidentified in 6%. Twenty-two percent of the patients had vascular insufficiency and/or were immunocompromised. History, physical exam, plain x-rays, and open biopsy and culture were most helpful in establishing the diagnosis. Laboratory studies and bone scans were less helpful. Cultures were positive in 74% of patients, with a noteworthy number of mixed infections (35%) and gram-positive infections (35%). Gram- negative infections accounted for 15%, fungal infections for 12%, and mycobacterial infections for 3%. Surgical management varied from simple curettage to more elaborate staged reconstructions and/or arthrodeses. Despite provision of aggressive surgical care and use of appropriate antibiotics, the overall amputation rate was 39% (18/46). A delay of more than 6 months from onset of symptoms to diagnosis and definitive treatment led to amputation in 6 of 7 patients (86%), 2 of whom had squamous-cell carcinoma. Of the 12 patients who underwent more than 3 surgical procedures, 8 ultimately underwent amputation and 2 had marked disability.
AB - The records of 700 patients with hand infections were reviewed. Forty- six (6%) had osteomyelitis of the metacarpals or phalangeal bones. The cause was post-traumatic in 57%, postoperative in 15%, hematogenous in 13%, spread from contiguous infections in 9%, and unidentified in 6%. Twenty-two percent of the patients had vascular insufficiency and/or were immunocompromised. History, physical exam, plain x-rays, and open biopsy and culture were most helpful in establishing the diagnosis. Laboratory studies and bone scans were less helpful. Cultures were positive in 74% of patients, with a noteworthy number of mixed infections (35%) and gram-positive infections (35%). Gram- negative infections accounted for 15%, fungal infections for 12%, and mycobacterial infections for 3%. Surgical management varied from simple curettage to more elaborate staged reconstructions and/or arthrodeses. Despite provision of aggressive surgical care and use of appropriate antibiotics, the overall amputation rate was 39% (18/46). A delay of more than 6 months from onset of symptoms to diagnosis and definitive treatment led to amputation in 6 of 7 patients (86%), 2 of whom had squamous-cell carcinoma. Of the 12 patients who underwent more than 3 surgical procedures, 8 ultimately underwent amputation and 2 had marked disability.
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UR - http://www.scopus.com/inward/citedby.url?scp=0030836415&partnerID=8YFLogxK
U2 - 10.1016/S0363-5023(97)80122-0
DO - 10.1016/S0363-5023(97)80122-0
M3 - Article
C2 - 9260620
AN - SCOPUS:0030836415
VL - 22
SP - 644
EP - 649
JO - The Hand
JF - The Hand
SN - 1753-1934
IS - 4
ER -