Staged treatment with bone cement insertion and autogenous iliac bone grafting for subacute/chronic phalangeal osteomyelitis in the hand

PurposeThis study investigates the efficacy of antibiotic-loaded bone cement followed by autogenous iliac bone grafting in managing subacute/chronic phalangeal osteomyelitis (OM), focusing on infection eradication, reconstruction of bone defects, and functional restoration.MethodsWe conducted retrospective analysis involving 14 patients treated between September 2007 and November 2023, with a mean follow-up duration of 18.21 months. The treatment protocol involved staged procedures, beginning with debridement and bone cement insertion, followed by cement extraction and autogenous bone grafting.ResultsComplete infection resolution was achieved for all patients, and radiological evidence of bone union was observed within an average of 46.93 days. Bone defects measured between 10 and 30 mm; most patients received cancellous bone grafts, although cortico-cancellous grafts were utilized in four cases. Functional outcomes, evaluated through the Quick disabilities of the arm, shoulder, and hand questionnaire, demonstrated marked improvement (49.78→10.33). The mean total active motion of the affected digits was 82.14%, with a majority attaining functional use. No cases of recurrent infection were identified, and the staged surgical method demonstrated effectiveness for digit preservation, including those with bone loss exceeding 10 mm.ConclusionThe authors suggest antibiotic-loaded bone cement insertion followed by autogenous iliac bone grafting can be a highly reliable and reproducible intervention for subacute/chronic phalangeal OM. We advocate this approach as a treatment option for phalangeal OM.