Surgical treatment features and rehabilitation approaches in patients with septic arthritis of the metacarpophalangeal and interphalangeal joints of the hand

Introduction. Hand trauma and the hand diseases are the socially significant problems. Septic arthritis of the metacarpophalangeal or interphalangeal joints are prone to aggressive course, with severe complications and inappropriate outcome, that is more likely in inadequately postponed or insufficient treatment. The indications for finger amputation in some studies were up to 26 %. Issues regarding the surgery technique and the rehabilitation approach remain the subject of discussion.

Purpose of the research. To analyze the features and results of surgical treatment, as well as approaches to rehabilitation after septic arthritis of the metacarpophalangeal and interphalangeal joints.

Materials and methods of research. The search and analysis of literary sources in the PubMed, Web of Science, Google Scholar databases, as well as in the Russian Science Citation Index (RSCI) system in the period from 1990 to 2022 was carried out. More than 50 scientific publications have been explored.

Conclusion. The analysis of treatment timing showed that immediate surgical intervention is of critical importance for the long-term result. Persistent dysfunction along with painful arthrosis after septic arthritis of the hand may be the reason for performing arthrodesis of the finger in about 40 % of patients. Immobilization is still a question for discussion: ranges from 24 hours to 4 weeks or more. Public attention should be pointed to the search of an effective strategies of the septic arthritis of the metacarpophalangeal and interphalangeal joints of the hand treatment.

1. Krainyukov P.E., Safonov O.V., Kolodkin B.B., Kolodkin B.B. [Septic-inflammatory diseases of the hand: modern features of complex treatment]. Gnojno-vospalitelnye zabolevaniya kisti: sovremennye osobennosti kompleksnogo lecheniya Bulletin of the N. I. Pirogov. National Medical and Surgical Center, 2016, pp. 48–54. (In Russ.)

2. McDonald L.S., Bavaro M.F., Hofmeister E.P., Kroonen L.T. Hand infections. J Hand Surg Am., 2011, № 36 (8), pp. 1403–1412. https://doi.org/10.1016/j.jhsa.2011.05.035

3. Koshy J.C., Bell B. Hand Infections. J Hand Surg Am., 2019, № 44 (1), pp. 46–54. https://doi.org/10.1016/j.jhsa.2018.05.027

4. Wright M.A. Septic arthritis of the wrist and the hand: An Emergency department case study. Int Emerg Nurs., 2022, № 62, рр. 101150. https://doi.org/10.1016/j.ienj.2022.101150

5. Chenoweth B. Septic Joints: Finger and Wrist. Hand Clin., 2020, № 36 (3), pp. 331–338. https://doi.org/10.1016/j.hcl.2020.03.006

6. Krainyukov P.E., Kokorin V.V., Kolodkin B.B., Safonov O.V. [Stages of development of surgery for septic infection of the hand and modern approaches to treatment]. Etapy razvitiya hirurgii gnojnoj infekcii kisti i sovremennye podhody k lecheniyu. Bulletin of the N. I. Pirogov. National Medical and Surgical Center, 2017, № 3, pp. 60–66. (In Russ.)

7. Teo WZW, Chung K.C. Hand Infections. Clin Plast Surg., 2019, № 46 (3), pp. 371–381. https://doi.org/10.1016/j.cps.2019.03.003

8. Hunter W. Of the structure and diseases of articulating cartilages. Philosophical Transactions of the Royal Society of London, 1743, № 42, pp. 514–522.

9. Brodie B.C. Pathological and Surgical Observations on Diseases of Joints. London. Longmans, 1819, 418 p.

10. Flynn J.E. Hand Surgery. Williams and Wilkins, Baltimore, 1966, pp. 597–614.

11. Zaitsev G.P. Acute septic infection of the hand and fingers (panaritium). M. : Medgiz, 1938, 108 p. (In Russ.). https://doi.org/10.14341/probl8602-1699

12. McBride S., Mowbray J., Caughey W., Wong E., Luey C., Siddiqui A., Alexander Z., Playle V., Askelund T., Hopkins C., Quek N., Ross K., Orec R., Mistry D., Coomarasamy C., Holland D. Epidemiology, Management, and Outcomes of Large and Small Native Joint Septic Arthritis in Adults. Clin Infect Dis., 2020, № 70 (2), pp. 271–279. https://doi.org/10.1093/cid/ciz265

13. Sendi P., Kaempfen A., Uçkay I., Meier R. Bone and joint infections of the hand. Clin Microbiol Infect., 2020, № 26 (7), pp. 848–856. https://doi.org/10.1016/j.cmi.2019.12.007

14. Angly B., Steiger R., Zimmerli W. Infektiöse Arthritis der Fingergelenke [Septic arthritis of finger joints]. Handchir Mikrochir Plast Chir., 2007, № 39 (2), pp. 118–123. https://doi.org/10.1055/s-2007-965137

15. Lamou H.J., Kim S., Kuchenbuch C., Thelen S., Eisenschenk A., Hakimi M. Gelenkinfektionen an Hand und Handgelenk [Septic Arthritis of the Hand and Wrist]. Handchir Mikrochir Plast Chir., 2021, № 53 (3), pp. 290–295. https://doi.org/10.1055/a-1512-0321

16. Kwak S.H., Bae J.Y., Oh Y., Jang H.S., Ahn T.Y., Lee S.H. Primarily treated patients versus referred patients in the treatment of native septic arthritis of digits: a retrospective comparative study. BMC Musculoskelet Disord., 2020, № 21(1), p. 780. https://doi.org/10.1186/s12891-020-03770-9

17. Ferrand J., El Samad Y., Brunschweiler B., Grados F., Dehamchia-Rehailia N., Séjourne A., Schmit J.L., Gabrion A., Fardellone P., Paccou J. Morbimortality in adult patients with septic arthritis: a three-year hospitalbased study. BMC Infect Dis., 2016, № 1 (16), p. 239. https://doi.org/10.1186/s12879-016-1540-0

18. Meier R., Wirth T., Hahn F., Vögelin E., Sendi P. Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration? Open Forum Infect Dis., 2017, № 4 (2), рр. ofx058. https://doi.org/10.1093/ofid/ofx058

19. Unglaub F., Langer M.F., Unglaub J.M., Hohendorff B., Müller L.P., Hahn P., Löw S., Spies C.K. Gelenkinfektionen der Hand [Joint infections of the hand]. Unfallchirurg, 2016, № 119 (11), pp. 943–953. https://doi.org/10.1007/s00113-016-0261-6

20. Tsuji K., Takahashi H., Fukano R., Sekiguchi M. Septic Arthritis of the Hand during Treatment of Complex Regional Pain Syndrome. Open Journal of Orthopedics, 2018, № 8, pp. 317–321. https://doi.org/10.4236/ojo.2018.88034

21. Spies C.K., Hohendorff B., Löw S., Müller L.P., Oppermann J., Hahn P., Unglaub F. Die Fingerendgelenkversteifung mit der Doppelgewindeschraube [Arthrodesis of the distal interphalangeal joint using the headless compression screw]. Oper Orthop Traumatol, 2017, № 29.

22. Usoltseva B.V., Mashkara K.I. Surgery of diseases and injuries of the hand. M. : Medicine, 1986, 352 p. (In Russ.)

23. Brown H. Hand infections. Amer. Fam. Physician, 1978, № 18 (3), pp. 515–523.

24. Sammer D.M., Shin A.Y. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. Surgical technique. J Bone Joint Surg Am., 2010, № 92 (1), pp. 107–113. https://doi.org/10.2106/JBJS.I.01315

25. Rotunno T., Müller C., Heidekrueger P., Gjika E., Gauthier M., Lauper N., Beaulieu J-Y., Erba P., Christen T., Uçkay I. Outcomes of Septic Joint Arthritis of the Hand: A DualCenter Study. Clin Surg., 2019, № 4, pp. 1–5.

26. https://doi.org/10.5167/uzh-183928

27. Boustred A.M., Singer M., Hudson D.A., Bolitho G.E. Septic arthritis of the metacarpophalangeal and interphalangeal joints of the hand. Ann Plast Surg., 1999, № 42 (6), pp. 623–628. https://doi.org/10.1097/00000637-199906000-00007

28. Curtiss Jr., Klein L. Destruction of articular cartilage in septic arthritis. II. In vivo studies. J Bone Joint Surg Am., 1965, № 47 (8), pp. 1595–1604.

29. Chung S.R., Kang Y.C., McGrouther D.A. Techniques for Continuous Irrigation of Septic Joints of the Hand. Tech Hand Up Extrem Surg., 2019, № 23 (3), pp. 133–137. https://doi.org/10.1097/BTH.0000000000000241

30. Sinha M., Jain S., Woods D.A. Septic arthritis of the small joints of the hand. J Hand Surg Br., 2006, № 31 (6), pp. 665–672. https://doi.org/10.1016/j.jhsb.2006.08.011