Compartmental infections of the hand

Abstract

Suppurative conditions of the hand-wrist compartments result in a "vicious circle" of infection and increase in compartmental pressure that reduces perfusion of soft tissues and facilitates spreading of the infection. We have assessed the outcome of such infections in relation to the infecting pathogen, delay in diagnosis, and method of treatment. Fifty-nine patients were treated with drainage, irrigation, and antibiotics and followed up for 6-58 (median 18) months. Staphylococcus aureus was detected in 29 of 39 cultures (74%) that grew pathogens. At the latest follow-up results were excellent in 49 cases. Sixteen required reoperation or readmission. There was a significant association between final range of movement (ROM) and extent of infection (p = 0.01). The type of pathogen was also significantly associated with a worse outcome (p = 0.03 for ROM, p = 0.04 for DASH). These infections have poor results when treatment is delayed or inadequate, as a result of the extended infection, inadequate drainage or inappropriate antibiotic treatment of certain types of bacteria.