A 7-Year Retrospective Review of Flexor Sheath Infections

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Hand Surgery

Background:

• Flexor sheath infections necessitate prompt diagnosis and treatment, typically involving antibiotics and surgical intervention, with reported complication rates up to 38%.
• A conservative approach utilizing an outpatient antibiotic service for select flexor sheath infection cases has been implemented.

Purpose of the Study:

• To compare the complication rates between outpatient and inpatient management of flexor sheath infections.
• To evaluate the safety and efficacy of a conservative, non-surgical outpatient management strategy for flexor sheath infections.

Main Methods:

• Retrospective review of patients diagnosed with flexor sheath infections between January 2014 and December 2020.
• Data collected included patient demographics, comorbidities, infection etiology, management strategy (inpatient vs. outpatient), and subsequent complications.

Main Results:

• A total of 128 patients were analyzed; 11% (n=14) were managed as outpatients, while 89% (n=114) were admitted.
• Overall complication rate was low at 6% (n=8), with no statistically significant difference highlighted between outpatient and inpatient groups.
• 77% of all patients underwent surgical washout, but 23% were managed with intravenous antibiotics alone.

Conclusions:

• A significant proportion of flexor sheath infections (11%) can be safely and effectively managed in an outpatient setting with intravenous antibiotics.
• Conservative outpatient management appears to be a safe alternative to inpatient admission for select patients with flexor sheath infections, challenging the necessity of routine surgical washout.