Catheter irrigation for treatment of pyogenic closed space infections of the hand

We studied 29 patients admitted to San Francisco General Hospital with flexor tenosynovitis (6 patients), pyogenic arthritis (17 patients), and deep space infections (6 patients). All patients underwent catheter irrigation of the infected space for at least 48 hours postoperatively. In 23 patients no further operative procedures were required. Infection was controlled without amputation in all patients. Median hospital stay was the same for patients with tenosynovitis, pyogenic arthritis, and deep space infections (8 days). Thirteen of 17 patients followed for at least one month, including 7 of 9 patients with pyogenic arthritis, were found to have regained at least 50% of baseline motion. In this series the outcome of treatment for pyogenic arthritis was comparable to that for tenosynovitis. We believe that catheter irrigation should be considered as a treatment option in pyogenic arthritis. A prospective trial comparing the efficacy of treatment modalities for pyogenic arthritis is indicated.