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Murine Flexor Tendon Injury and Repair Surgery
Published on: September 19, 2016
Clinical Characteristics of Pyogenic Flexor Tenosynovitis in Pediatric Patients
Christopher M Brusalis1, Stephanie Thibaudeau2, Robert B Carrigan1
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Pyogenic flexor tenosynovitis (PFT) in children often presents with fewer than four Kanavel signs. Prompt surgical drainage and antibiotics targeting MRSA are crucial for successful treatment and infection resolution.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Infections
Background:
- Pyogenic flexor tenosynovitis (PFT) is a serious hand infection in children.
- Early diagnosis and treatment are critical to prevent complications such as joint stiffness and long-term morbidity.
- Understanding common pathogens and antimicrobial resistance patterns is essential for effective management.
Purpose of the Study:
- To characterize the clinical presentation of pediatric PFT.
- To identify common causative pathogens and their antimicrobial susceptibility.
- To evaluate treatment methods and outcomes for PFT in children.
Main Methods:
- Retrospective review of pediatric patients treated surgically for PFT from 2001-2015.
- Analysis of patient demographics, clinical signs (including Kanavel signs), culture results, and treatment strategies.
- Descriptive statistics to summarize findings and complications.
Main Results:
- Thirty-two pediatric patients were included; 62% presented with at least 3 Kanavel signs.
- Most common pathogens included MRSA (38%), MSSA (22%), and Pasteurella multocida (13%); 19% had polymicrobial infections.
- All patients received IV antibiotics and surgical incision and drainage (I&D); 18% required repeat I&D.
- Infection resolved in all cases with no neurovascular complications; average hospitalization was 5.1 days.
Conclusions:
- Kanavel signs are useful but not always present in pediatric PFT.
- Empirical broad-spectrum antibiotic therapy covering MRSA is vital due to resistance and polymicrobial infections.
- Prompt I&D and culture-guided antibiotics lead to predictable resolution of severe pediatric PFT.
Purpose:
To characterize the clinical presentation, common pathogens, antimicrobial susceptibility, and treatment methods associated with pyogenic flexor tenosynovitis (PFT) in pediatric patients.
Methods:
Patients who underwent surgical treatment for PFT at a large tertiary-care children's hospital between 2001 and 2015 were identified. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications.
Results:
Thirty-two patients (71.9% male) with a mean age of 9.5 ± 5.5 years (range, 0.8-19 years) were included. At least 3 Kanavel signs were present on presentation in 62% of the cohort, with all 4 signs identified in 34%. Three children (9%) presented with 0 to 1 Kanavel signs, with semiflexed posturing of the digit as the least commonly (41%) manifested sign. The most frequently cultured organisms were methicillin-resistant Staphylococcus aureus (MRSA) (38%), methicillin-sensitive S. aureus (22%), and Pasteurella multocida (13%). Multiple organisms were cultured in 19% of cases. Intravenous antibiotics were administered for a median duration of 4 days (range, 1-16 days) in all cases. Organisms were sensitive to the initial antibiotic regimen in 81% of cases. All methicillin-resistant S. aureus infections were sensitive to vancomycin and trimethroprim-sulfamethoxazole, and 83% were sensitive to clindamycin. Incision and drainage (I&D) was performed in all cases, with 18% of patients requiring repeat I&D. Surgical approaches included limited incision (80%), midaxial incision (13%), and Bruner incision (7%). The average length of hospitalization was 5.1 days. Infection resolved in all cases without readmission. No neurovascular complications were identified.
Conclusions:
The presence of Kanavel signs at presentation are a meaningful indicator of PFT, but are not uniformly present on examination in children and adolescents. Owing to the prevalence of antimicrobial resistance and polymicrobial infection, empirical antibiotic therapy using broad-spectrum agents with MRSA coverage is essential. In our cohort of pediatric patients with PFT of sufficient severity to warrant surgical management, prompt I&D along with culture-guided antibiotics predictably resolves infection.
Type Of Study/Level Of Evidence:
Therapeutic IV.
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