gms | German Medical Science

Objectives/Interrogation: In pyogenic arthritis of the digits, when diagnosed lately, drainage sinus may occur. Because of combined osteomyelitis, soft tissue destruction, and cartilage damage, it is difficult to treat this situation. In this study, we reviewed 36 cases of chronic pyogenic arthritis with drainage sinus in digits and (1) reported the result of repeated irrigation and debridement followed by flap surgery, and (2) compared the clinical manifestation between distal interphalangeal (DIP) joint and proximal interphalangeal (PIP) joint.

Methods: 36 patients (16 men and 20 women, 41-80 years of age with a mean age of 60.1 years) were diagnosed with chronic pyogenic arthritis with drainage sinus. The involved joints (21 DIP joints, 12 PIP joints, 2 thumb interphalangeal (IP) joints, 1 thumb metacarpophalangeal (MCP) joint) underwent surgical debridement and followed up for at least 12 months. Combined osteomyelitis in simple radiograph or magnetic resonance image, microorganism, antibiotic therapy, duration of treatment delay, duration of hospital stay, number of irrigation and debridement (I&D), and soft tissue coverage method were analyzed retrospectively. The range of motion (ROM) of the joint and radiologic outcome at final follow up were also analyzed.

Results and Conclusions: Combined osteomyelitis was diagnosed in 30 cases. Microorganisms were identified in 29 cases and 7 were polymicrobial infections. The identified microorganisms were resistant to the antibiotics used before, except one case.

In the group analysis between DIP and PIP joint, mean duration of antibiotic therapy (5.9 ± 0.31 weeks, DIP; 7.6 ± 0.66 weeks, PIP; p<0.001) was significantly longer in PIP joints and patients involved their PIP joints had more I&D than those involved DIP joints (2.9 ± 0.84, DIP; 6.5 ± 1.7, PIP; p<0.001). Eight patients (n=0, DIP; n=8, PIP; p<0.001) underwent additional flap surgery. Three patients with involved DIP joint and 10 with involved PIP joint, the joints were fused (p<0.001). The mean ROM was 5.57 degree (8.57±5.51 degree DIP; 0.83±2.88 degree PIP, p<0.001).

Chronic pyogenic arthritis with drainage sinus in digit could be treated with repeated irrigation and debridement. When PIP joint is involved, longer duration of treatment, more I&D, higher need of a flap surgery, and less ROM is expected compared with DIP joint. If empirical antibiotics was used before, the surgeon should perform antibiotic susceptibility test.