Septic arthritis of the hand: From etiopathogenesis to surgical treatment

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.