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
ARTICLE HIGHLIGHTS
Research 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. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.