This study is a retrospective review from Singapore of seventy-five patients that presented over a six-year period with pyogenic flexor tenosynovitis. The authors identified five risk factors associated with poor outcome which included age greater than 43 years, comorbidities of diabetes mellitus, peripheral vascular disease or renal failure, the presence of subcutaneous purulence, digital ischemia and polymicrobial infection. Based on the clinical findings and outcomes, the authors proposed three distinct groups with progressively worse outcomes. Patients in Group I had no subcutaneous purulence or digital ischemia: patients in Group II demonstrated the presence of subcutaneous purulence but no ischemic changes: and patients in Group III had both extensive subcutaneous purulence and ischemic changes. Group I had no amputations and a mean 80% return of total active motion. Group II had an 8% amputation rate and 72% return of total active motion. Group III had an amputation rate of 59% and a mean 49% return of total active motion. Patients over the age of 43 years old had a 4.5 times higher risk of amputation. The most common pathogen was staphylococcus aureus which was found in 43% of the cultures.
This study describes various risk factors leading to poor outcomes and provides a simple clinical classification system. Results of the study can be used to aid in counseling patients who present with clinical findings of pyogenic flexor tenosynovitis.
Pyogenic, Flexor, Tenosynovitis, Infection, Flexor, Tendon, Outcome