Osteomyelitis likely an issue with open finger fractures

PHILADELPHIA — Infections, such as osteomyelitis, are important to take into consideration in the management of open finger fractures, according to a presenter at the Annual Hand Surgery Symposium.

“The real issue is osteomyelitis,” Randall W. Culp, MD, of the Philadelphia Hand Center, said. “Most [infections] you see in your own practices result in contracted contamination by bad injuries… and knowing how to diagnose and deal with it is important.”

According to Culp, osteomyelitis will usually present with pain, swelling and erythema, and systemic signs are rare.

“It is very rare that somebody is going to come into your office and say I am sweating and feverish, I have had a temperature for 4 days and my finger is swollen,” Culp said. “They usually have much more subtle issues.”

Culp also noted that while the use of radiographs and MRI have high sensitivity and specificity in the diagnosis of osteomyelitis, blood work does not.

“I usually order [blood work] if I am not sure what is going on or I want to assess treatment, but they are not specific for osteomyelitis,” Culp said.

Culp added surgeons should utilize external fixation and fusion as treatment methods, as well as consult an infectious disease physician when an infection has not subsided after prescription of antibiotics, especially if a patient is in the hospital.—by Casey Tingle

Reference:

Culp RW. Infected fractures of the finger. Presented at: Annual Hand Surgery Symposium; March 7-9, 2015; Philadelphia.

Disclosure: Culp is a paid presenter or speaker for Auxilium and is a paid consultant for Biomet, Small Bone Innovations and Arthrex.