Terrence Jose Jerome J, Kumar Arun, Chandar Dr Mauli
European Diploma Hand Surgery, Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu, 620017, India.
Saveetha Institute of Medical and Technical Sciences, Saveetha Nagar, Thandalam, Kanchipuram Chennai Road, Chennai, Tamilnadu, 602105, India.
J Clin Orthop Trauma. 2025 Apr 19;66:103021. doi: 10.1016/j.jcot.2025.103021. eCollection 2025 Jul.
Distal phalanx osteomyelitis, although rare, represents a challenging infection that can have devastating functional and cosmetic consequences if inadequately managed. In patients with comorbidities-most notably diabetes mellitus-the infection may progress rapidly, causing bone destruction, soft tissue involvement, and ultimately, joint destruction. This review discusses the pathophysiology, diagnosis, and surgical management of distal phalanx osteomyelitis. It also highlights key gaps in the current literature, particularly the lack of standardized treatment protocols and limited long-term outcome data, aiming to provide a more consolidated approach to this complex condition. Drawing on current literature and our clinical experience, we outline indications and contraindications for surgery, evaluate imaging modalities and diagnostic criteria, describe detailed surgical techniques (including debridement, dead space management, and reconstruction), and examine the role of antibiotic therapy. We also propose a surgical algorithm based on the extent of infection and review potential complications and outcomes. The article emphasizes that early recognition and aggressive surgical management-coupled with culture-directed antibiotics-are key to optimizing hand function and preventing recurrence.
远端指骨骨髓炎虽然罕见，但却是一种具有挑战性的感染，如果处理不当，可能会导致严重的功能和外观后果。在患有合并症（最显著的是糖尿病）的患者中，感染可能迅速进展，导致骨质破坏、软组织受累，并最终导致关节破坏。本综述讨论了远端指骨骨髓炎的病理生理学、诊断和手术治疗。它还强调了当前文献中的关键空白，特别是缺乏标准化的治疗方案和有限的长期结果数据，旨在为这种复杂疾病提供一种更综合的治疗方法。借鉴当前文献和我们的临床经验，我们概述了手术的适应症和禁忌症，评估了成像方式和诊断标准，描述了详细的手术技术（包括清创、死腔处理和重建），并研究了抗生素治疗的作用。我们还根据感染程度提出了一种手术算法，并回顾了潜在的并发症和结果。本文强调，早期识别和积极的手术治疗，再加上根据培养结果使用抗生素，是优化手部功能和预防复发的关键。
