Conservative treatment for pyogenic flexor tenosynovitis: a single institution experience

Area of Science:

• Hand surgery
• Infectious diseases
• Orthopedic surgery

Background:

• Pyogenic flexor tenosynovitis (PFT) is a common hand infection.
• Delayed treatment can lead to severe functional loss and amputation.
• Surgical irrigation and debridement is the standard treatment, but conservative options are less understood.

Purpose of the Study:

• To evaluate the outcomes of conservative treatment for PFT using intravenous (IV) antibiotics.
• To assess the efficacy and complication rates of non-operative management for PFT.

Main Methods:

• Retrospective case series of 46 patients treated conservatively for PFT between 2000 and 2013.
• Data collected included demographics, comorbidities, clinical presentation (Kanavel's signs), inflammatory markers, treatment course, length of stay (LOS), and functional outcomes.
• Patients received inpatient empirical IV antibiotic therapy under specialist surveillance.

Main Results:

• The average time from symptom onset to presentation was 4.6 days.
• 82.2% of patients had elevated inflammatory markers.
• 69% of patients achieved full or minimally limited final flexion range of motion (ROM); the complication rate was 4.3% with no finger loss.

Conclusions:

• Inpatient empirical IV antibiotic therapy is a viable option for uncomplicated pyogenic flexor tenosynovitis (PFT).
• Conservative management should be considered when supervised by a hand specialist.
• This approach can yield good functional outcomes and a low complication rate.