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Delayed debridement affects prognosis in patients with purulent flexor tenosynovitis: a retrospective cohort and multivariate analyses

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Abstract

Introduction

Purulent flexor tenosynovitis (PFT) is a severe condition, and many patients report serious postoperative complications such as amputation, limited range of motion (ROM), or recurrence of symptoms. However, the ideal protocol for PFT treatment remains unknown owing to the limited number of studies. This retrospective cohort study aimed to identify prognostic factors for PFT treatment outcomes.

Materials and methods

Sixty-six patients (46 men and 20 women) with PFT who underwent surgical debridement at our hospital between September 2005 and January 2023 were included in this study. We conducted multivariate linear regression analysis with permanent deficit as the primary outcome. We defined the number of operations, laboratory data, interval from onset to debridement, previous conservative treatment, aetiology, Kanavel’s signs, and medical history of diabetes mellitus as possible prognostic factors. We also defined the interval from onset to debridement as a secondary outcome and performed logistic regression analysis.

Results

Overall, 25 (38%) patients had postoperative deficits. Longer interval from onset to surgery (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.0–1.1) and polymicrobial infection (OR: 7.8, 95% CI: 1.56–38.8) were significant prognostic factors for unfavourable outcomes. Additional multivariate analysis showed that preoperative conservative treatment prolonged the interval to surgery (estimate, 16.4; standard error, 1.6; p < 0.05).

Conclusions

The results of this study suggest that indications for nonoperative treatment of PFT are limited and that earlier surgical debridement is recommended.

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Acknowledgements

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic and Hand Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan

    Yuki Fujihara, Ai Sakai, Satoshi Niwa, Hideyuki Ota & Hiroaki Kumagai

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  1. Yuki Fujihara
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  2. Ai Sakai
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  3. Satoshi Niwa
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  4. Hideyuki Ota
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  5. Hiroaki Kumagai
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yuki Fujihara, Ai Sakai, Satoshi Niwa, Hideyuki Ota, and Hiroaki Kumagai. The first draft of the manuscript was written by Yuki Fujihara, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yuki Fujihara.

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Research involving human participants and/or animals

The institutional review board of our hospital approved this study (Approval No. 2023-017).

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Informed consent was not required, because de-identified data were used. The patients could opt out of participation.

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Fujihara, Y., Sakai, A., Niwa, S. et al. Delayed debridement affects prognosis in patients with purulent flexor tenosynovitis: a retrospective cohort and multivariate analyses. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05269-7

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