Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2022; 13(11): 993-1005
Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.993
Septic arthritis of the hand: From etiopathogenesis to surgical treatment
Konstantin V Lipatov, Arthur Asatryan, George Melkonyan, Aleksandr D Kazantcev, Ekaterina I Solov’eva, Irina V Gorbacheva, Alexander S Vorotyntsev, Andrey Y Emelyanov
Konstantin V Lipatov, Aleksandr D Kazantcev, General Surgery Department, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
Arthur Asatryan, General Surgery Department, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115142, Russia
George Melkonyan, General Surgery Department, The Hospital for War Veterans N3, Moscow 129336, Russia
Ekaterina I Solov’eva, Irina V Gorbacheva, Alexander S Vorotyntsev, Andrey Y Emelyanov, General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
Author contributions: Lipatov KV performed conceptualization and manuscript writing, review, and editing; Asatryan A and Melkonyan G performed methodology and writing of the original draft; Kazantcev AD performed visualization and manuscript writing, review, and editing; Solov’eva EI and Gorbacheva IV performed investigation and writing of the original draft; Vorotyntsev AS and Emelyanov AY performed formal analysis and supervision.
Institutional review board statement: The study was reviewed and approved by the I.M. Sechenov First Moscow State Medical University Institutional Review Board (Approval No. 03-22).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at lipatov_k_v@staff.sechenov.ru.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantin V Lipatov, Doctor, MD, Doctor, Full Professor, General Surgery Department, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), 11-2 Rossolimo Street, Moscow 119021, Russia. lipatov_k_v@staff.sechenov.ru
Received: July 26, 2022
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
Abstract
BACKGROUND

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. An inflammation can cause dysfunction of the joint, and in the most severe cases, the need for amputation of the finger may arise. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory. Urgent surgical treatment is extremely important in septic arthritis of the hand, as it helps to prevent cartilage destruction and the development of osteomyelitis.

AIM

To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results, depending on the nature of the damage to the articular structures.

METHODS

The results of the treatment of 170 patients with septic arthritis of the hand, which were treated in the period of 2020-2021, were analyzed. Inflammation of the interphalangeal and metacarpophalangeal joints (MCP) of fingers 1, 2, and 3 was more often noted in 147 (81.6%) joints. The most common cause of arthritis was a penetrating injury as a result of household trauma (101, 59.4%), animal bite (30, 17.6%), and clenched fist injury (15, 8.8%). Septic arthritis with contiguous osteomyelitis was observed in 98 (54.4%) cases. Surgical treatment was completed with drainage and irrigation of the joint. Early mobilization was used to restore function. In patients with osteomyelitis, it was aimed at the formation of neoarthrosis. Arthrodesis was not applied. Long-term results of treatment were assessed in 142 (83.5%) patients within 1 mo to 12 mo after discharge from the hospital [the median was 7 mo (IQR: 4-9)].

RESULTS

The most commonly isolated organism was Staphylococcus aureus (35.3%). The median treatment delay in patients without osteomyelitis was 5 d (IQR: 4-7); for septic arthritis with contiguous osteomyelitis, it was 14 d (IQR: 5-21). Radiography for osteomyelitis within 2 wk was uninformative: 41.2% of diagnoses. A single surgical treatment was required in 138 (81.2%) patients, two treatments in 22 (12.9%), and three or more in 10 (5.9%). Total elimination of the infection was achieved in 163 (95.9%) patients. The best functional results of treatment were noted in patients without osteomyelitis. After septic arthritis, Total Active Motion (TAM) for the MCP was 96.2% (IQR: 85.1-98.0), for the proximal interphalangeal joint (PIP) 82.4% (IQR: 54.5-98.5), and for the distal interphalangeal joint (DIP) 69.4% (IQR: 65.4-74.1). In cases with osteomyelitis, it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2% (IQR: 45.3-90.1), for PIP-62.5% (IQR: 41.8-68.9), and for DIP-59.4% (IQR: 50-62.1). Additionally, the severity of pain during movements did not exceed 1 point.

CONCLUSION

The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis, especially in the presence of diabetes mellitus. Urgent surgical treatment, along with continued irrigation of the joint and antibiotic therapy, made it possible to eliminate the infection, and early rehabilitation restored the range of motion. The best results were noted in patients without osteomyelitis. With the development of osteomyelitis, a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis, without resorting to arthrodesis.

Keywords: Septic arthritis; Osteomyelitis; Hand; Surgical treatment; Neoarthrosis

Core Tip: The timing of surgical treatment initiation is extremely important in septic arthritis of the hand. Prompt and timely surgical intervention can prevent the destruction of cartilage and the development of osteomyelitis. In the presence of osteomyelitis, surgical debridement followed by early rehabilitation aimed at developing neoarthrosis may be an alternative to traditional treatment using arthrodesis. This conception makes it possible to largely preserve the range of active motions in the affected joint.