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DOI: 10.1055/a-1394-6332
Osteitis/Osteomyelitis an Hand und Handgelenk
Osteitis/Osteomyelitis of the Hand and Wrist
Zusammenfassung
Die Osteomyelitiden im Bereich von Handgelenk und Hand sind weniger häufig als die Knocheninfektionen der langen Röhrenknochen, aber nicht selten. Viele Fragen zur Klassifikation, Pathogenese, Diagnostik, zum Therapiemanagement sowie den erreichbaren Behandlungsergebnissen sind bisher nur wenig ausreichend wissenschaftlich kontrolliert. Die Pathogenese der Erkrankung kann in posttraumatische, postoperative, fortgeleitete und hämatogene Osteomyelitiden, unter Erfassung der patientenindividuellen Risiken, eingeteilt werden. Eine frühe Diagnose und eine adäquate Therapie sind notwendig, um die betroffenen knöchernen Strukturen sowie die Funktion der angrenzenden Gelenke zu erhalten. Ein mehrzeitiges operatives Vorgehen ist dabei häufig notwendig. Zufriedenstellende Raten der Infektionskontrolle und erfolgreiche knöcherne Rekonstruktionen können meist erreicht werden. Komplikationen, verbleibende Defizite und partielle Amputationen, auch bei angemessener Therapie der Osteomyelitiden, sind auf Grund der Schwere der Erkrankung aber nicht immer zu verhindern.
Abstract
Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning this disease. This includes careful consideration of the prevalence, pathogenesis, microbiology, diagnostic methods and the conservative, medical and surgical treatment. The emergence of the disease can subdivided in post-traumatic, postoperative, spread from contiguous infections and hematogenous. The individual patient-specific risk must be considered. Early diagnosis and correct management are essential to preserve bony structures and the articular function of the hand. A two-step surgical procedure is usually necessary, but uncertainties about the optimal treatment are still existing. Satisfactory control rates of the infection and successful bone reconstructions can be achieved. But complications, a limited range of motion and amputations of finger parts can still not be avoided in all cases.
Schlüsselwörter
Osteomyelitis - Knocheninfektion - Hand und Handgelenk - konservative Therapie - operative TherapieKey words
Osteomyelitis - bone infection - hand and wrist - conservative treatment - surgical treatmentID https://orcid.org/0000-0002-8856-6441
Publication History
Received: 14 February 2021
Accepted: 15 February 2021
Article published online:
16 June 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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Literatur
- 1 Honda H, McDonald JR. Current recommendations in the management of osteomyelitis of the hand and wrist. J Hand Surg Am 2009; 34: 1135-1136 DOI: 10.1016/j.jhsa.2009.03.020.
- 2 Pinder R, Barlow G. Osteomyelitis of the hand. J Hand Surg Eur Vol 2015; 41: 431-440 DOI: 10.1177/1753193415612373.
- 3 Reilly KE, Linz JC, Stern PJ. et al. Osteomyelitis of the tubular bones of the hand. J Hand Surg Am 1997; 22: 644-649
- 4 Strecker W, Russ M, Schulte M. Hämatogene Osteomyelitis des Erwachsenen. Orthopäde 2004; 33: 273-286 DOI: 10.1007/s00132-003-0601-4.
- 5 Jansson A, Jansson V, vonLiebe A. Die kindliche Osteomyelitis. Orthopäde 2009; 38: 283-294 DOI: 10.1007/s00132-008-1402-6.
- 6 Romanò CL, Romanò D, Logoluso N. et al. Bone and joint infections in adults: a comprehensive clossification proposal. Eur Orthop Traumatol 2011; 1: 207-217
- 7 Tiemann AH, Braunschweig R, Hofmann GO. Knocheninfektionen. Unfallchirurg 2012; 115: 480-488 DOI: 10.1007/s00113-012-2187-y.
- 8 Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. Int J Infect Dis 2006; 10: 315-319 DOI: 10.1016/j.ijid.2005.06.009.
- 9 Sendi P, Kaempfen A, Uckay I. et al. Bone and joint infection of the hand. Clin Microbiol Infect 2020; 26: 848-856 DOI: 10.1016/j.cmi.2019.12.007.
- 10 Barbieri R, Freeland A. Osteomyelitis of the hand. Hand Clin 1998; 14: 589-603
- 11 McLain RF, Steyers C, Stoddard M. Infections in open fractures of the hand. J Hand Surg Am 1991; 16: 108-112 DOI: 10.1016/s0363-5023(10)80022-x.
- 12 Cierny G, Mader J, Penninck J. A clinical staging system for adults osteomyelitis. Contemp Orthop 1985; 10: 17-37
- 13 Gonzalez MH, Nikoleit J, Weinzweig N. et al. Upper extremity infections in patients with the human immunodeficiency virus. J Hand Surg Am 1998; 23: 348-352
- 14 Luginbuhl J, Solarz MK. Complications of hand infections. Hand Clin 2020; 36: 361-367 DOI: 10.1016/j.hcl.2020.03.01030).
- 15 Webb LX, Bosse MJ, Castillo RC. et al. Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fractures. J Bone Joint Surg Am 2007; 89: 923-928 DOI: 10.2106/JBJS.F.007765).
- 16 Gonzalez MH, Papierski P, Hall RF. Osteomyelitis of the hand after a human bite. J Hand Surg Am 1993; 18: 520-522 DOI: 10.1016/0363-5023(93)90104-B.
- 17 Kheiran A, Palial V, Rollett R. et al. Cat bite: an injury not to underestimate. J Plast Surg Hand Surg 2019; 53: 341-346 DOI: 10.1080/2000656X.2019.1637750.
- 18 Malahias M, Jordan D, Hughes O. et al. Bite injuries of the hand: microbiology, virology and management. Open Orthop J 2014; 27: 157-161 DOI: 10.2174/1874325001408010157.
- 19 Nakanishi A, Kawamura K, Omokawa S. et al. Reconstruction of a metacarpal head defect due to bite injury: two case reports. Case Reports Plast Surg Hand Surg 2018; 25: 62-67
- 20 Lyengar KP, Nadkarni JB, Gupta R. et al. Mycobacterium chelonae hand infection following ferret bite. Infection 2013; 41: 237-241 DOI: 10.1007/s15010-012-0309-7.
- 21 Liaw F, Murray O, Tan YY. et al. Retained foreign body in a diabetic patient’s hand. Open Orthop J 2018; 14: 203-207 DOI: 10.2174/1874325001812010203..
- 22 Narayan N, Edwards D, Ragoowansi RH. Glove and PICO: a novel technique for treatment of chronic wound due to osteomyelitis of the hand. BMJ Case Rep 2014; 2: 1-4 DOI: 10.1136/bcr-2013-202780.
- 23 Heppert V, Glatzel U, Wentzensen A. Postoperative und bakterielle Osteitis. Orthopäde 2004; 33: 316-326 DOI: 10.1007/s00132-003-0607-y.
- 24 Kaandorp CJ, Dinant HJ, vandeLaar MA. et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997; 56: 470-475 DOI: 10.1136/ard.56.8.470.
- 25 Lenz M, Hofmann GO, Mückley T. Diagnose und Therapie periprothetischer Infektionen. Unfallchirurg 2012; 115: 496-502 DOI: 10.1007/s00113-012-2189-9.
- 26 Polzer H, Neu J. Late infections after open reduction and internal fixation of the upper ankle joint. Unfallchirurg 2012; 115: 552-553 DOI: 10.1007/s00113-012-2166-3.
- 27 Rieger U, Brug E, Langer M. Das Panaritium. 1. Aufl.. München: Hans Marseille; 1992
- 28 Eisenschenk A, Bauwens K, Böttcher R. et al. Osteomyelitis der Mittelhand- und Handwurzelregion. Z Orthop 2005; 143: 479-485
- 29 Sauerbier M, Eisenschenk A, Krimmer H. et al. Die Handchirurgie. München: Urban & Fischer; 2015
- 30 Kang G, Leow MQH, Tay SC. Wrist inflammation: a retrospective comparison between septic and non-septic arthritis. J Hand Surg Eur Vol 2018; 43: 431-437 DOI: 10.1177/1753193417738166.