Osteomyelitis and septic arthritis of the hand and wrist
Osteomyelitis and septic arthritis of the hand and wrist require prompt recognition and early treatment to minimize adverse sequelae. A rational treatment approach assesses the pathogenesis, microbiology, medical and surgical treatment options. Direct inoculation is the most common cause of septic arthritis or osteomyelitis, with Staphylococcus aureus the most frequent offending pathogen. The increasing incidence of community and hospital-acquired methicillin resistant Staphylococcus aureus (MRSA) requires special consideration and should be considered early in the treatment of hand infections. Open surgical debridement of the bone or joint is the preferred treatment. In the radiocarpal joint, arthroscopic irrigation and debridement is an effective treatment method with a shorter period of hospitalization and equivalent results in the intermediate term. Long-term parenteral and oral antibiotics combined with a short period of splint immobilization are integral in the postoperative period. Despite early and aggressive treatment, stiffness, recurrent infection, pain and deformity may persist. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
