• K-P Vorderwinkler, M Mühldorfer, T Pillukat, and J van Schoonhoven.
• Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland. karl-paul.vorderwinkler@gmx.at
• Oper Orthop Traumatol. 2011 Jul 1; 23 (3): 192-203.

ObjectiveRadical debridement of joint infection, prevention of further infection-related tissue destruction.IndicationsSeptic arthritis of interphalangeal joints in the thumb and fingers.ContraindicationsExtensive soft tissue defects. Severe impairment of blood circulation, finger gangrene. Noncompliance for immobilization or for treatment with external fixator.Surgical TechniqueArthrotomy and irrigation with isotonic solution. Radical tissue debridement. Joint preservation possible only in the absence of infection-related macroscopic cartilage damage. Otherwise, resection of the articular surfaces and secondary arthrodesis. Insertion of antibiotic-coated devices. Temporary immobilization with external fixator.Postoperative ManagementInpatient postoperative treatment with 5-day intravenous administration of a second-generation cephalosporine (e.g., Cefuroxim®) followed by 7-10 days oral application. Adaptation of antibiotics according to antibiogram results. In joint-preserving procedures, radiographs and fixator removal after 4 weeks, active joint mobilization. If joint surfaces were resected, removal of fixator after 6 weeks; arthrodesis under 3-day intravenous broad-band antibiotic prophylaxis. Splint immobilization until consolidation (6-8 weeks).ResultsIn 10 of 40 patients, the infected joint could be preserved. All infections healed. After an average duration of therapy of 6 (3-11) weeks, 4 individuals were free of complaints, and 6 patients had minor symptoms. Overall range of motion in the affected finger was reduced by 25-50° in 5 patients. All patients could return to work after 6.6 (4-11) weeks. A total of 30 patients were treated with joint resection and external fixator. After 5.6 (4-8) weeks, arthrodesis was performed, leading to consolidation in 29 patients. One patient underwent amputation after 4 months due to delayed gangrene. Treatment duration was 15.7 (7-25) weeks. Eight patients reported no complaints, 14 suffered mild symptoms, 5 had moderate, and 3 had severe symptoms in daily life. In 15 cases, range of motion was diminished by 10-80° in the remaining joints of the affected finger. Patients could return to work after 16.2 (6-28) weeks.

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