Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.993
Peer-review started: July 26, 2022
First decision: September 26, 2022
Revised: October 3, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 18, 2022
Processing time: 112 Days and 16.5 Hours
Septic arthritis of the hand, which is the second most common after damage of the knee joint, remains one of the leading causes of temporary disability. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory.
Dissatisfaction with the results of the treatment of septic arthritis of the hand, including a significant number of cases of joint stiffness and even amputations of the fingers, followed by the loss of the ability of patients to engage in their usual work activities, which is a severe psychological trauma, motivated us to find ways to solve this problem.
To explore the etiology and clinical course of septic arthritis of the hand; to analyze the timing of the development of osteomyelitis with a delay in the treatment of patients; and to compare approaches to surgical treatment and rehabilitation depending on the nature of the pathological process.
The results of treatment of 170 patients with septic arthritis of the hand were retrospectively analyzed. The causes of the disease and the nature of the microbial flora were explored. The frequency of various forms of septic arthritis of the hand and approaches to surgical treatment were analyzed.
The most common pathogen was S. aureus. The form of septic arthritis was largely determined by the duration of treatment delay. In the presence of osteomyelitis, it was maximal. In patients with diabetes mellitus, osteomyelitis developed much earlier. Comprehensive treatment made it possible to eliminate the infection. Functional outcomes were better in patients without osteomyelitis. With the development of osteomyelitis, surgical debridement and early rehabilitation made it possible to partially restore the range of motion without resorting to arthrodesis.
Timely surgical treatment of septic arthritis of the hand allows reducing the number of cases of osteomyelitis. Early rehabilitation is the key to success in restoring hand function after surgery. The development of osteochondral destruction does not exclude the possibility of partial restoration of function due to the formation of neoarthrosis.
To optimize approaches to the surgical treatment of septic arthritis of the hand and postoperative rehabilitation, it is necessary to develop a specialized classification of this disease, taking into account the involvement in the pathological process of not only the elements of the joint, but also the paraarticular soft tissues and flexor/extensor tendons of the finger.