Operative Pediatric Hand Infections: A Retrospective Review

Abstract

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 preexisting 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 onequarter 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.

Establishing the Role of Inflammatory Markers in the Diagnosis and Treatment of Acute Hand Infections in the Pediatric Population

“…To date, there has not been a study of the relevance of inflammatory markers associated with different types of pediatric hand and wrist infections, and their ability to predict the need for invasive treatment. [15][16][17] In this sample, levels of inflammatory blood markers at presentation were not predictive of the definitive management strategy ultimately used to treat the infection. Existing literature remains conflicted regarding the predictive value of acute phase reactants in determining management.…”

“…These identified the causative organisms of the infection and the number of procedures required for the treatment of various diagnoses. To date, there has not been a study of the relevance of inflammatory markers associated with different types of pediatric hand and wrist infections, and their ability to predict the need for invasive treatment 15–17 …”