Outcome of the Management of Patients with Tropical Diabetic Hand Syndrome.

Abstract

Background: Tropical Diabetic Hand Syndrome (TDHS) is an acute, rapidly progressive hand infection affecting patients with diabetes mellitus (DM), often following trivial trauma. Unlike those with diabetic foot disease, neuropathy and vasculopathy play a minor role, while poor glycaemic control, delayed presentation, and minor injuries are key risk factors. TDHS is often not recognised in Nigeria despite its potential for disability and mortality. This study reviews the management outcomes of patients presenting with TDHS at a tertiary hospital in Nigeria.

Methodology: A retrospective review was conducted of all patients with DM managed for TDHS at the Jos University Teaching Hospital from 2015 to 2024. Data were extracted on socio-demographics, type and duration of diabetes, clinical presentation, treatment, and outcomes. Descriptive statistics were applied using SPSS version 25.

Results: Thirteen patients were included: mean age 45.4 ± 11.2 years, with a female predominance (61.5%). Most (92.3%) had type 2 diabetes of a median duration of 6 years, and poor glycaemic control was observed in 86.6%. Abscesses (53.8%) and ulcers (30.8%) were the commonest presentations, predominantly affecting the digits (61.5%). Incision and drainage with dressings (that included the use of povidone iodine) was the main surgical treatment, while flap cover was rarely required. The mean hospital stay was 26.5 ± 23.9 days. Outcomes were favourable in 86.6% (discharged), with one death (7.7%) and one patient leaving against medical advice.

Conclusions: TDHS remains a preventable but serious complication of diabetes in Nigeria, predominantly affecting middle-aged women with poorly controlled type 2 diabetes. Prompt surgical and medical management yielded favourable outcomes, but prolonged hospitalisation and mortality highlight its burden. Strengthening diabetes care, patient education, and clinician awareness are vital to reducing incidence and improving outcomes.