Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty.
HondaHMcDonaldJR. Current recommendations in the management of osteomyelitis of the hand and wrist. J Hand Surg Am. 2009;34(6):1135-1136. 2009/06/02. DOI: 10.1016/j.jhsa.2009.03.020.
2.
PinderRBarlowG. Osteomyelitis of the hand. J Hand Surg Eur Vol. 2016;41(4):431-440. 2015/10/21. DOI: 10.1177/1753193415612373.
3.
CiernyGIIIMaderJTPenninckJJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res2003;414:7-24. DOI: 10.1097/01.blo.0000088564.81746.62.
4.
LipatovKVAsatryanAMelkonyanG, et alNew classification for septic arthritis of the hand. World J Orthop. 2023;14(2):85-89. 20230218. DOI: 10.5312/wjo.v14.i2.85.
5.
LiHKRombachIZambellasR, et alOral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019;380(5):425-436. 2019/01/31. DOI: 10.1056/NEJMoa1710926.
6.
McMeekinNGeueCBriggsA, et alCost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Res. 2019;4:108. DOI: 10.12688/wellcomeopenres.15314.1.
7.
SendiPKaempfenAUçkayI, et alBone and joint infections of the hand. Clin Microbiol Infect. 2020;26(7):848-856. DOI: 10.1016/j.cmi.2019.12.007.
8.
GjikaEBeaulieuJYVakalopoulosK, et alTwo weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial. Ann Rheum Dis. 2019;78(8):1114-1121. 2019/04/18. DOI: 10.1136/annrheumdis-2019-215116.
9.
MeierRWirthTHahnF, et alPyogenic arthritis of the fingers and the wrist: can we shorten antimicrobial treatment duration?Open Forum Infect Dis. 2017;4(2):ofx058. 2017/05/12. DOI: 10.1093/ofid/ofx058.
10.
MoherDLiberatiATetzlaffJ, et alPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
11.
WymanMDarganDKazzaziD, et alSerum inflammatory markers and amputations in hand osteomyelitis: a retrospective review of 146 cases. Hand. 2023;18(6):987-993. DOI: 10.1177/15589447211066346.
12.
WymanMDarganDCaddickJ, et alHand osteomyelitis in arterial calcification, diabetes mellitus and end-stage renal failure: a comparison of 210 cases over 12 years. J Hand Surg Eur. 2021;46(7):768-773. DOI: 10.1177/1753193420981871.
13.
HaqueAWymanMDarganD, et alHand osteomyelitis in patients with secondary Raynaud phenomenon. J Clin Rheumatol. 2021;27(8):S342-S345. DOI: 10.1097/RHU.0000000000001621.
14.
DarganDWymanMRonanD, et alA microbiological analysis of 210 cases of hand osteomyelitis. Clin Infect Pract. 2021;12(Nov 2021):100102. DOI: 10.1016/j.clinpr.2021.100102.
15.
HenryMLundyFH.Oral antibiotic management of acute osteomyelitis of the hand: outcomes and cost comparison to standard intravenous regimen. Hand2021;16(4):535-541. DOI: 10.1177/1558944719873145.
16.
LipatovKVAsatryanAMelkonyanG, et alSeptic arthritis of the hand: from etiopathogenesis to surgical treatment. World J Orthop. 2022;13(11):993-1005. 20221118. DOI: 10.5312/wjo.v13.i11.993.
17.
ReillyKELinzJCSternPJ, et alOsteomyelitis of the tubular bones of the hand. J Hand Surg Am. 1997;22(4):644-649. DOI: 10.1016/S0363-5023(97)80122-0.
18.
EisenschenkABauwensKBottcherR, et alOsteomyelitis of the carpus and metacarpus. Z Orthop Ihre Grenzgeb. 2005;143(4):479-485. 2005/08/25. DOI: 10.1055/s-2005-836743.
19.
GonzalezMHPapierskiPHallRFJr.Osteomyelitis of the hand after a human bite. J Hand Surg Am1993;18(3):520-522. DOI: 10.1016/0363-5023(93)90104-B.
20.
McLainRFSteyersCStoddardM.Infections in open fractures of the hand. J Hand Surg Am. 1991;16(1):108-112. DOI: 10.1016/S0363-5023(10)80022-X.
21.
AiméVLKidwellJTWebbLH.Single-stage treatment of osteomyelitis for digital salvage by using an antibiotic-eluting, methylmethacrylate joint-spanning spacer. J Hand Surg Am. 2017;42(6):480.e481-480.e487. DOI: 10.1016/j.jhsa.2017.02.015.
22.
OkumuraTKomuraSHirakawaA, et alTwo-stage reconstruction using a vancomycin-impregnated cement spacer for finger osteomyelitis with bone and joint destruction. Hand Surg Rehabil. 2024;43(1):101602. DOI: 10.1016/j.hansur.2023.09.369.
23.
GillPLambahA.Osteomyelitis of the hand. Trauma. 2014;16(1):48-50. DOI: 10.1177/1460408613504067.
24.
OkadaMKamanoMUemuraT, et alPedicled adipose tissue for treatment of chronic digital osteomyelitis. J Hand Surg Am. 2015;40(4):677-684. DOI: 10.1016/j.jhsa.2014.12.034.
25.
SubasiMBukteYKapukayaA, et alTuberculosis of the metacarpals and phalanges of the hand. Ann Plast Surg. 2004;53(5):469-472. 2004/10/27. DOI: 10.1097/01.sap.0000130708.80606.6a.
26.
RomanoCLRomanoDLogolusoN, et alBone and joint infections in adults: a comprehensive classification proposal. Eur Orthop Traumatol. 2011;1(6):207-217. 2011/08/13. DOI: 10.1007/s12570-011-0056-8.
27.
XuGGYamATeohLC, et alEpidemiology and management of surgical upper limb infections in patients with end-stage renal failure. Ann Acad Med Singapore. 2010;39(9):670.
28.
BensonLSEdwardsSLSchiffAP, et alDog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am. 2006;31(3):468-473. 2006/03/07. DOI: 10.1016/j.jhsa.2005.12.011.
29.
SmithHRConyardCLoveridgeJ, et alPredicting amputation and multiple debridements in tooth knuckle injuries. J Hand Surg Asian Pac Vol. 2019;24(1):6-12. 2019/02/15. DOI: 10.1142/S2424835519500024.
30.
FrancelTJMarshallKASavageRC.Hand infections in the diabetic and the diabetic renal transplant recipient. Ann Plast Surg. 1990;24(4):304-309.
31.
SharmaKPanDFriedmanJ, et alQuantifying the effect of diabetes on surgical hand and forearm infections. J Hand Surg Am. 2018;43(2):105-114. 2017/12/16. DOI: 10.1016/j.jhsa.2017.11.003.
32.
GibsonEBettlachCRPayneE, et al. Predictors of digital amputation in diabetic patients with surgically treated finger infections.Hand. 2024;19(2):269-77. DOI: 10.1177/15589447221082.
WeinzweigNGonzalezM. Surgical infections of the hand and upper extremity: a county hospital experience. Ann Plast Surg. 2002;49(6):621–627. DOI: 10.1097/00000637-200212000-00012.
35.
HoushianSSeyedipourSWedderkoppN.Epidemiology of bacterial hand infections. Int J Infect Dis. 2006;10(4):315-319. 2006/02/18. DOI: 10.1016/j.ijid.2005.06.009.
36.
KetonisCDwyerJIlyasAM.Timing of debridement and infection rates in open fractures of the hand. Hand. 2017;12(2):119-126. DOI: 10.1177/1558944716643294.
37.
SennevilleÉAlbalawiZVan AstenSA, et alIWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Clin Infect Dis2024;40(3):e3687. DOI: 10.1093/cid/ciad527.
38.
SunYGaoYChenJ, et alEvidence mapping of recommendations on diagnosis and therapeutic strategies for diabetes foot: an international review of 22 guidelines. Metabolism. 2019;100:153956. 2019/08/09. DOI: 10.1016/j.metabol.2019.153956.
39.
Expert Panel on Musculoskeletal Imaging, PierceJLPerryMT, et alACR appropriateness criteria suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot): 2022. J Am Coll Radiol2022;19(11):S473-487. DOI: 10.1016/j.jacr.2022.09.013.
40.
Korean Society for Chemotherapy, Korean Society of Infectious Diseases and Korean Orthopaedic Association. Clinical guidelines for the antimicrobial treatment of bone and joint infections in Korea. Infect Chemother. 2014;46(2):125-138. 2014/07/16. DOI: 10.3947/ic.2014.46.2.125.
41.
HenryM.Free vascularized medial femoral condyle structural flaps for septic terminal digital bone loss. J Hand Microsurg. 2015;7(2):306-313. 2015/11/19. DOI: 10.1007/s12593-015-0207-1.
42.
MetsemakersWMorgensternMMcnallyMA, et alFracture-related infection: a consensus on definition from an international expert group. Injury. 2018;49(3):505-510. DOI: 10.1016/j.injury.2017.08.040.
43.
GovaertGAMKuehlRAtkinsBL, et alDiagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. 2020;34(1):8-17. 2019/12/20. DOI: 10.1097/BOT.0000000000001614.
