Management of potentially infected complex hand injuries

Fifteen patients with contaminated, and thus potentially infected, hand injuries were treated. All had segmental bone loss: six metacarpals, three proximal phalanges, three middle phalanges, and three joint injuries. The treatment was based on the simultaneous primary application of external minifixators and antibiotic-loaded bone cement beads and completed by early bone grafting. This external fixation and internal antibiotic treatment has synergic effect both mechanically and biologically. Thus potentially infected fresh injuries were treated in exactly the same way as an established osteomyelitis. Although there were a few minor wound problems and superficial pin tract infections, there were no deep infections, and no bone grafts were lost. All of the patients were grafted with autologous bone taken from the ilium within 7 to 8 days. Rehabilitation time was markedly decreased by this method, and all of the patients returned to work within 8 months.