Hand osteomyelitis in arterial calcification, diabetes mellitus and end-stage renal failure: a comparison of 210 cases over 12 years

Wyman, Matthew; Dargan, Dallan; Caddick, Jennifer; Giblin, Victoria

doi:10.1177/1753193420981871

Cited by 6 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Confounding variables, including diabetes mellitus and peripheral vascular disease, which are associated with systemic inflammation and elevated inflammatory markers even in the absence of infection, were prevalent among patients requiring amputation (33/64 [52%] and 15/64 [23%] respectively). 31 - 34 Our study found that 43 of the 48 patients (90%) with either diabetes mellitus or end-stage renal failure had elevated CRP at diagnosis, compared with 46/73 (63%) without.…”

Section: Discussionmentioning

confidence: 64%

Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

Wyman

Dargan

Kazzazi

et al. 2022

Hand (New York, N,Y.)

Self Cite

View full text Add to dashboard Cite

Background: The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. Methods: We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. Results: Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). Discussion: C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.

show abstract

Section: Discussionmentioning

confidence: 64%

Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

Wyman

Dargan

Kazzazi

et al. 2022

Hand (New York, N,Y.)

Self Cite

View full text Add to dashboard Cite

show abstract

“…Understanding poor prognosticators may be helpful in counseling patients and treating infections. A retrospective analysis of 210 patients with osteomyelitis of the hand showed that, when arterial calcification was present, there were increased risks of polymicrobial infection, additional surgical procedures, and delayed digital amputation, and a higher mortality rate at 1 and 5 years 45 . Thus, early amputation in patients with arterial calcification may optimize disease-free survival.…”

Section: Infectionmentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

show abstract

“…2 Many of these pathologies manifest in patients requiring dialysis due to the increased presence of arterial calcification and steal syndrome. 3,4 As a result, approximately 5% of patients with end-stage renal disease (ESRD) will develop symp-tomatic upper extremity ischemia. 5 In those who present with fingertip ischemia eventually requiring UEA, high mortality has been described.…”

Section: Introductionmentioning

confidence: 99%

“…5 In those who present with fingertip ischemia eventually requiring UEA, high mortality has been described. 4,6 Conservative management of nonhealing fingertip wounds includes lifestyle modification, pharmacotherapy to increase blood flow and treat infections, and local wound care. 2 Patients nonresponsive to these treatments may require more invasive intervention in the form of operative wound debridement, revascularization, or reconstruction using skin grafting, skin substitutes, or local/free tissue transfer.…”

Section: Introductionmentioning

confidence: 99%

“…6,[8][9][10] It has been postulated that conservative management of hand wounds in patients with ESRD may lead to delayed healing and overall morbidity. 4 Currently, there is sparse guidance in the literature related to best management of patients with ESRD and nonhealing wounds. 4,6 The purpose of this study was to evaluate outcomes of UEA in patients with ESRD with fingertip wounds and to define risk factors for complications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Refining Treatment Strategies in Patients With Fingertip Wounds and End-Stage Renal Disease

Vishwanath

Rao

et al. 2023

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Background: Individuals with end-stage renal disease (ESRD) and fingertip wounds are at high risk of poor wound healing, ultimately requiring amputations. Optimal performance of upper extremity amputation (UEA) in patients with ESRD is important to decrease complications and minimize total operative procedures needed. This study evaluated outcomes of UEA in patients with ESRD and described risk factors predisposing patients to complications. Methods: A retrospective analysis of patients receiving nontraumatic UEA for fingertip wounds was conducted, stratified by patients with and without ESRD. Demographics, comorbidities, complications, and hospital course were analyzed between groups for differences. Subanalysis of patients with ESRD was conducted to characterize operative course and predictors of complications. Results: A total of 132 patients were included, 106 controls and 26 with ESRD. Compared with controls, patients with ESRD required more amputations ( P < .001) and total operations ( P < .001) to achieve wound healing. Patients with ESRD experienced higher rates of postoperative complications ( P < .001). Predictors for complications in patients with ESRD were comorbid diabetes (odds ratio [OR]: 45; 95% confidence interval [CI], 1.7-1226.9), vascular disease (OR: 30; 95% CI, 2-441.8), arterial calcification (OR: 18; 95% CI, 1.56-207.5), and presence of a hemodialysis shunt in the affected arm (OR: 18; 95% CI, 1.56-207.5). Within patients with ESRD, initial amputation at, or proximal to, the metacarpophalangeal joint (MCPJ) led to fewer amputations (1.2 vs 2.19, P = .04) and fewer total operative procedures (4.1 vs 6.6, P = .03), compared with initial amputation distal to the MCPJ. Conclusion: In nontraumatic fingertip wounds, patients with ESRD had worse operative outcomes than patients without ESRD. More aggressive management of fingertip wounds using earlier and more proximal initial amputations may expedite wound healing in certain high-risk patients with ESRD.

show abstract

Hand osteomyelitis in arterial calcification, diabetes mellitus and end-stage renal failure: a comparison of 210 cases over 12 years

Cited by 6 publications

References 20 publications

Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

What’s New in Hand and Wrist Surgery

Refining Treatment Strategies in Patients With Fingertip Wounds and End-Stage Renal Disease

Contact Info

Product

Resources

About