Comparison of Outcomes in Surgical Treatment of Pyogenic Flexor Tenosynovitis: Hand Surgeons Versus Other Orthopedic Subspecialists.

Abstract

Background: Call patterns among hospital systems vary. At our institution, most pyogenic flexor tenosynovitis (FTS) patients receive irrigation and debridement (I&D) from non-hand-trained orthopedic specialists on call. Our hypothesis was that there would be no outcome differences among patients managed by hand surgeons versus non-hand surgeons.

Materials and methods: This was a retrospective cohort study of patients who underwent I&D for FTS over a six-year period. Demographic data, mechanism of injury, past medical history, laboratory results indicating inflammation, time to the operating room, and Kanavel signs were collected. Outcomes were range of motion (ROM) and pain at last follow-up, return to OR (RTOR) rate, and need for amputation. A significance level of P<0.05 was used.

Results: There were 128 patients and 153 digits with a postoperative diagnosis of FTS that underwent I&D. The most common medical comorbidities were diabetes, peripheral vascular disease, and end-stage renal disease. The most common presenting signs were pain with passive extension and resting digital flexion, but most patients presented with all four Kanavel signs. The RTOR rates for non-hand-and hand-trained surgeons were 22% and 26%, respectively (P>0.05). There were no significant differences when comparing postoperative pain and ROM, as well as RTOR rates. Amputation rates among non-hand and hand surgeons were similar at 7% and 5%, respectively (P>0.05).

Conclusions: There were no significant differences in outcomes, RTOR rates, or amputations among non-hand-versus hand-trained orthopedic surgeons acutely managing FTS. Surgical treatment for FTS should not be delayed if a hand surgeon is unavailable. [Orthopedics. 202x;4x(x):xx-xx.].