| Diagnosis and Treatment for Deep Nontuberculous Mycobacteria Infection of the Hand and Wrist |
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Ho Youn Park, Jun O Yoon, Jin Woong Park, Jaeyoun Yoon, Jim Sam Kim |
1Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea.
2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. micro@amc.seoul.kr |
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Received: 11 June 2015 • Revised: 27 August 2015 • Accepted: 27 August 2015 |
| Abstract |
Purpose
The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes.
Methods
10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively.
Results
Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20degrees, volar flexion 15degrees, radial deviation 0degrees, ulnar deviation 15degrees.
Conclusion
Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist. |
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