Risk Factors for Nonunion After Distal Phalangeal Fractures of the Hand.

PURPOSE: This study aimed to evaluate the risk factors for distal phalanx fracture nonunion. METHODS: We retrospectively reviewed all adult patients treated for distal phalanx fractures at our institution between January 2015 and December 2019 with a minimum one-year follow-up period for potential risk factors. The absence of consolidation signs on follow-up radiographs at least 12 months after trauma was defined as nonunion. RESULTS: This study included 124 patients with 143 fractures available for follow-up. Nonunion was diagnosed in 19 patients, 18 of whom initially presented with an open fracture. On the day of the injury, 17 patients with open fractures presented to the hospital. In 16 nonunion cases, the traumatic mechanism was a crush injury. All nonunions occurred in tuft fractures, and none required revision surgery at the follow-up visit. CONCLUSIONS: Our findings suggest that tuft involvement in open fractures is the main risk factor for nonunion of distal phalangeal fractures. However, after a minimum of 1 year of follow-up, none of the tuft nonunions required revision surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Ochrobactrum anthropi Infection of the Hand.

Ochrobactrum anthropi is an opportunistic, low-virulence pathogen occasionally associated with human infections and found largely in immunocompromised patients and those with intravascular devices. We report the case of a healthy 70-year-old man who presented with an infection of the hand, who had no history of trauma but had been gardening for 4 months. Despite surgical debridement and empirical antibiotics, the infection could not be controlled. Cultures revealed O anthropi. Antibiotic treatment was adapted to intravenous cefepime for 15 days and the infection was finally controlled after a second surgery. Oral cotrimoxazole was continued for another 2 weeks. Ochrobactrum anthropi infection of the hand must be considered not only in immunosuppressed patients but also in healthy patients without intravascular devices. Local debridement and empiric antibiotic may be insufficient. Antibiotic therapy should follow susceptibility testing, but usually includes a broad-spectrum intravenous beta-lactam such as imipenem-cilastatin or cefepime, or oral cotrimoxazole or ciprofloxacin.