Management and outcomes of acute hand and wrist infections in low- and middle-income countries : a systematic review and meta-analysis.

Aims: Acute hand and wrist infections can be devastating, with a substantial burden in low- and middle-income countries (LMICs) compared with high-income countries. Access to treatment, particularly surgery, can be limited. This study aimed to determine the management and outcomes of hand and wrist infections in LMICs.

Methods: A PRISMA-compliant systematic review and meta-analysis was conducted (Prospective Register of Systematic Reviews (PROSPERO) CRD420250631145) within MEDLINE, EMBASE, Global Health, Global Index Medicus, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science from database inception to December 2024. Studies of acute bacterial hand and wrist infections managed in LMICs, reporting at least one outcome, were included. Primary outcomes were risk of amputation and mortality.

Results: Of 18,208 abstracts screened, 39 full-text studies with 4,130 patients were included. These were mostly retrospective case series, from Africa and Asia. Mean age was 45.0 years (SD 9.3), with a male preponderance (63.3%, n = 1,804). Over half of studies (n = 22) focused on diabetic hand and wrist infections. Deep space infections were the most common infection. Mean delay to presentation was 11.8 days (SD 6.1) and surgery was required for source control in 89.4% of patients (n = 3,693). Mean length of stay for admitted patients was 12.2 days (SD 14.1). Meta-analysis demonstrated a 26.1% (95% CI 16.8 to 36.4) risk of amputation (31 studies), rising to 32.7% (95% CI 21.3 to 45.0) in studies of diabetic patients. Mortality risk was 2.8% (95% CI 1.0 to 5.3; 18 studies). Functional and socioeconomic outcomes were rarely reported. Risk of bias was assessed as moderate or high in 85% of studies (n = 33).

Conclusion: Hand and wrist infections in LMICs often present late and have high rates of amputation and death, particularly among diabetic patients. Future research is needed to mitigate delayed presentation and develop interventions focused on saving life and limb.