[Infections of the Proximal and Distal Interphalangeal Joint: 4 weeks of Immobilisation between initial Surgery with Joint Resection and secondary Joint Fusion is sufficient].

BACKGROUND In 2011 we published our treatment regime for infections of the interphalangeal joints of the hand with infection-related macroscopic cartilage damage. We recommended the resection of the infected joint followed by 6 weeks of immobilisation by external fixation before secondary arthrodesis. In 2013 we reduced the period of immobilisation to 4 weeks within a prospective study. PURPOSE This paper analyses the effect of a shortened immobilisation time of 4 instead of 6 weeks between joint resection and secondary joint fusion in bacterial infection of the proximal and distal interphalangeal joint. PATIENTS AND METHODS Between March 2013 and July 2014, 20 patients with an infection of an interphalangeal joint of the hand were treated by joint resection and secondary arthrodesis after a reduced time of immobilisation of 4 weeks. The patients were clinically and radiologically evaluated at median of 5,8 (4,7-10,5) months. The results were statistically analysed and compared with the previous study published 2011. RESULTS The reduced immobilisation period from 6 to 4 weeks did not result in a significant difference of revisions (p = 0.148). In 18 of 20 patients, the joint infection was reliably cured and the following arthrodesis consolidated. One patient required a revision surgery due to a persistent joint infection, a second patient got a revision surgery after arthrodesis because of a displaced implant. The range of motion of the infected finger was median 147.5 (30-220)°. Achieving a grip strength of 26 (4-64) kg, the affected hand reached 88.5 (47,8-223,1) % of the strength of the opposite side. The subjective functioning of the hand was good (DASH 37.9 (3.3-71.7), Krimmer-Score 2 (1-4)). We did not observe any persistent pain at rest (VAS 0 (0-3)) or under daily activities (VAS 1.3 (0-7)). 50 % of patients stated a sensitivity to cold. Our study of 2011 revealed similar results (ROM of the infected finger 142.5 (30-220)°, grip strength 95 (33-127)%, DASH-Score 23.3 (0-130), Krimmer Score 2 (1-4), VAS at rest 0 (0-7), VAS under stress 4.5 (0-9), sensitivity to cold in 41 % of 27 patients). CONCLUSION A decreased immobilisation period from 6 to 4 weeks between joint resection and secondary arthrosis for infections of the interphalangeal joints of the hand do not lead to a negative outcome. The described therapeutical regime results in reliable cure of the bacterial joint infection with a good function of the finger and only minor subjective discomfort.