Surgical management for distal phalanx osteomyelitis: A narrative review

Distal phalanx osteomyelitis, although rare, represents a challenging infection that can have devastating functional and cosmetic consequences if inadequately managed. In patients with comorbidities-most notably diabetes mellitus-the infection may progress rapidly, causing bone destruction, soft tissue involvement, and ultimately, joint destruction. This review discusses the pathophysiology, diagnosis, and surgical management of distal phalanx osteomyelitis. It also highlights key gaps in the current literature, particularly the lack of standardized treatment protocols and limited long-term outcome data, aiming to provide a more consolidated approach to this complex condition. Drawing on current literature and our clinical experience, we outline indications and contraindications for surgery, evaluate imaging modalities and diagnostic criteria, describe detailed surgical techniques (including debridement, dead space management, and reconstruction), and examine the role of antibiotic therapy. We also propose a surgical algorithm based on the extent of infection and review potential complications and outcomes. The article emphasizes that early recognition and aggressive surgical management-coupled with culture-directed antibiotics-are key to optimizing hand function and preventing recurrence.