Orthopedic Surgery for Hand Infections Workup

  • Author: Matthew B Klein, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Apr 19, 2011
 

Laboratory Studies

  • Complete blood cell (CBC) count: An elevated white blood cell count can indicate the presence of infection. In the case of particularly severe infections, the CBC test may provide a measure of the patient's progress.
  • Prothrombin time (PT) and activated partial thromboplastin time (aPTT): Obtain these tests before surgical treatment in patients who are receiving long-term anticoagulant therapy.
  • Glucose level: Check glucose levels in all patients with a history of diabetes. In those patients with active infections, blood-glucose levels are often elevated and difficult to control. Furthermore, blood-glucose control is important for wound healing. It is also important to check the glucose levels of any patient who has a history of frequent or particularly severe infections to rule out occult diabetes.
  • Chemistry panel: In general, check the chemistry panel of patients who have a history of dehydration (secondary to vomiting or sepsis). Check the chemistry panel of elderly patients before surgery.
  • Erythrocyte sedimentation rate (ESR): The ESR is elevated in cases of septic arthritis and osteomyelitis. However, patients with inflammatory arthritis may have elevated ESRs without infection.
  • If there is a clinical suspicion of septic arthritis, a joint aspirate should be sent for Gram staining, culturing, and sensitivity testing. In addition, cell count assessment, glucose and protein level determinations, and crystal analysis help in distinguishing between an infected joint and a joint with inflammatory arthritis or gout/pseudogout.
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Imaging Studies

  • Plain radiographs (3 views of the hand) are important to rule out the presence of foreign bodies, fractures, and subcutaneous air, which could indicate gas gangrene or acute or chronic osteomyelitis.
  • Magnetic resonance imaging (MRI) may be helpful for assessing soft-tissue abscess(es) and osteomyelitis.
  • Ultrasonography may reveal soft-tissue abscess(es).
  • Bone scanning, indium-111 (111 In) radionuclide studies, or computed tomography (CT) scanning may be useful for evaluating osteomyelitis.
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Contributor Information and Disclosures
Author

Matthew B Klein, MD  Attending Surgeon, Assistant Professor, UW Burn Center and Division of Plastic Surgery, Harborview Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

James Chang, MD  Assistant Professor of Plastic Surgery and Orthopedic Surgery, Program Director, Department of Plastic Surgery, Stanford University Medical Center

James Chang, MD is a member of the following medical societies: American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter M Murray, MD  Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital

Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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