Predictive factors for outcomes in pyogenic flexor tenosynovitis: a 10-year analysis of 341 patients

Pyogenic flexor tenosynovitis (PFT) is a surgical emergency that requires prompt diagnosis and treatment to prevent severe hand dysfunction. This study aims to identify epidemiological, clinical, and therapeutic factors influencing outcomes in a large cohort of adult patients.

We conducted a retrospective observational study of 341 adult patients treated for PFT at a tertiary university hospital between January 2015 and January 2025. Diagnosis was based on Kanavel's signs, and severity was graded using the Michon classification. Functional outcomes were evaluated using the Strickland and Glogovac criteria, DASH scores, and grip strength at final follow-up. Predictors were examined using bivariate correlation and multivariable regression analysis.

The median age was 48 years with a male predominance (56.0%). The most common clinical sign was fusiform swelling (87%). Staphylococcus aureus was the predominant pathogen (43.4%). Surgical management primarily involved lavage and debridement (53.7%) or necrosectomy (34.9%). Amputation was required in 11.4% of cases. Functional outcomes were excellent or good in 68.9% of patients. Advanced Michon stage at presentation significantly correlated with higher DASH scores and loss of grip strength. After multivariable adjustment, consultation delay (adjusted OR 1.13 per day, 95% CI 1.02-1.25), diabetes mellitus (aOR 3.19, 95% CI 1.51-6.72) and Michon stage (aOR 8.71 per level, 95% CI 4.61-16.48) remained independent predictors of an unfavourable functional outcome, and polymicrobial infection independently predicted a higher DASH score (β 5.83, 95% CI 2.50-9.15).

Early presentation and aggressive management are critical for favorable outcomes in PFT. The absence of pain on passive extension in advanced stages is a grave prognostic sign indicating tissue necrosis rather than improvement.