Osteomyelitis of the hand

Abstract

Osteomyelitis of the hand is uncommon. We report five (three women and two men) cases of delayed presentation of osteomyelitis. Two developed from septic arthritis, one followed a nailbed injury, one resulted from a chronic paronychia and one occurred spontaneously, and all cases presented to our department at least three weeks after the initial insult following treatment in Accident and Emergency or minor injuries department with antibiotics. Four patients underwent surgical exploration and debridement, with samples taken for bone culture which yielded Staphylococcus capitis, Staphylococcus epidermidis, Proteus miribilis and mixed anaerobes; one case was diagnosed clinically and radiologically and managed conservatively. Osteomyelitis should be considered as a differential diagnosis in patients presenting with persistent undiagnosed hand symptoms. Delayed diagnosis can lead to destruction of bony architecture with associated morbidity. Clinical outcome may be improved by early diagnosis, adequate surgical debridement and appropriate antibiotic therapy.