Frequency of patients presenting with Hand Infection and treatment modalities

Abstract

Introduction: Infections of the hand are one of the most common infections reported by the caring physicians and surgeons. Common types of hand infections include: bite wounds, felon, necrotizing fasciitis, paronychia, flexor tenosynovitis, subcutaneous/cellulitis, osteomyelitis and septic arthritis. Aims: The aim of this study to identify the main etiological factors, possible complications due to acute hand infection and treatment modalities performed in our selected group of patients. Materials and Method: This was a prospective Cross Sectional Observational Study based on 58 patients conducted at King Abdullah Hospital, Bisha, Saudi Arabia. Period of study was one year from May 2022 to April 2023. Patients of all age group were included. Male patients were 16 (27.5%) while females were 42 (72.4%). Result: Most of the patients were gardener / farmer 15 (25.9%), minor children 12 (20.7%), and housewife / maid 9 (15.5%). Major mechanism of injury was penetrating trauma 41 (70.7%). Majority of the patients were between 20 years to 50 years of age group. The risk factors associated with hand infection includes diabetes mellitus 13 (22.4%) and hypertension 5 (8.6%). The smokers were 13 (22.4%) patients. Most of the patients were Saudi national 30 (51.7%) followed by Egyptian12 (20.7%), Pakistani and Sudanese 4 (6.9% each). Surgical intervention includes, incision and drainage in 40 (68.9%) cases while amputation was performed in 3 (5.2%) cases. There were 15 (25.9%) patients treated with conservative treatment protocol. Major organisms causing infection was staphylococcus aureus 28 (48.30%) including methicillin resistant staphylococcus aureus (MRSA). There was no growth in 5 (8.6%) patients and for 19 (32.8%) patients no drainage collection was available and therefore their samples were not analyzed for bacteriology. We have categorized the diagnosis into 6 groups as subcutaneous infection 27 (41.5%), acute Paronychia 11 (16.9%), web space infection 10 (15.4%), pulp space infection7 (10.8%), flexor tenosynovitis 6 (9.2%) and midpalmer/thenar 4 (6.2%). Conclusion: Early clinical diagnosis based on occupational history and control of co-morbid disease such as diabetes mellites, smoking etc is effective in the treatment and prevention of hand infection to avoid devastating surgical intervention of partial or total diabetic hand amputation.