Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management

Abstract

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.Level of Evidence: IV.

Keywords: amputation; bone diseases; debridement; hand injuries; infectious; osteomyelitis.

Figure 1.

Flow diagram demonstrating the search and selection process for the review.

Figure 2.

International consensus definition of fracture-related infection (FRI) (reproduced with permission from Elsevier, from Metsemakers et al).

Figure 3.

Treatment options for osteomyelitis in the bones of the hand (reproduced with permission from Elsevier, from Aimé et al).

Figure 4.

Surgical technique for pedicled adipose tissue transfer, showing retrograde-flow pedicle (a and b), and anterograde-flow pedicle (c and d), with pedicle (P) and digital nerve (N) (reproduced with permission from Elsevier, from Okada et al).