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Operative Pediatric Hand Infections: A Retrospective Review
Luke J Grome1, Sarth Raj1, Amjed Abu-Ghname1
1Division of Plastic Surgery.
Insights
Pediatric hand infections, often from trauma, are common and usually require one surgery. Staphylococcus aureus, including MSSA and MRSA, is the most frequent cause, with most cases needing minimal intervention.
Area of Science:
- Pediatric Hand Surgery
- Infectious Diseases
- Orthopedic Surgery
Background:
- Pediatric hand infections are understudied compared to adult cases.
- Current management often extrapolates adult treatment protocols.
- This study addresses the unique aspects of pediatric hand infections requiring surgery.
Purpose of the Study:
- To evaluate the epidemiology of pediatric hand infections.
- To analyze the management strategies for these infections.
- To determine the outcomes of operative interventions for pediatric hand infections.
Main Methods:
- Retrospective chart review of pediatric patients undergoing operative intervention for hand infections.
- Data collected included demographics, infection characteristics, management details, and patient outcomes.
- Study conducted over a 7-year period at a major children's hospital.
Main Results:
- Fifty-seven pediatric patients were included.
- Discrete abscesses were the most common infection type.
- Staphylococcus aureus (MSSA/MRSA) was the predominant pathogen (58%).
- Osteomyelitis was present in 23% of cases.
- Median hospital stay was 3 days, with a 12.5% reoperation rate.
Conclusions:
- Hand infections are prevalent in children, frequently linked to trauma and abscesses.
- Methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are common culprits.
- Most pediatric hand infections resolve with a single operation and brief wound care.
Background:
Infections in the pediatric population are a less well studied topic in hand surgery. Crucial aspects of the management of pediatric hand infections differ from adults, though much of current treatment is generalized from adult care. This study evaluates our clinical experience with regards to the epidemiology, management, and outcomes of pediatric hand infections requiring operative intervention.
Methods:
A 7-year retrospective chart review was performed of all pediatric patients who required operative intervention for hand infections at Texas Children's Hospital. Clinical information was collected and analyzed, including demographics, infection characteristics, management, and outcomes.
Results:
Fifty-seven patients met the inclusion criteria for our study over the 7-year period. Of these, 7% (n=4) had a pre-existing diagnosis of diabetes mellitus, and 5% (n=3) had a recent history of upper extremity infections. The most common infection was a discrete abscess, whereas urgent/emergent conditions represented 25% (n=14) of infections. Radiographic changes consistent with osteomyelitis were present in over one-quarter of patients (n=13, 23%). The median length of hospital stay was 3 days (95% confidence interval: 3.05-5.05) and the most common pathogen was Staphylococcus aureus (n=33, 58%), with slightly more being methicillin sensitive (MSSA) than resistant (MRSA) (n=19, 33% vs. n=14, 25%). The incidence of reoperation was 12.5% (n=7).
Conclusions:
Hand infections are a common problem in the pediatric population. Cases tend to be associated with accidental trauma and discrete abscesses colonized by MSSA/MRSA. The vast majority of cases require only one operation and a short course of wound care before discharge.
Level Of Evidence:
Level IV-therapeutic study.
