Staged treatment with bone cement insertion and autogenous iliac bone grafting for subacute/chronic phalangeal osteomyelitis in the hand

Purpose: This study investigates the efficacy of antibiotic-loaded bone cement followed by autogenous iliac bone grafting in managing subacute/chronic phalangeal osteomyelitis (OM), focusing on infection eradication, reconstruction of bone defects, and functional restoration. Methods: We conducted retrospective analysis involving 14 patients treated between September 2007 and November 2023, with a mean follow-up duration of 18.21 months. The treatment protocol involved staged procedures, beginning with debridement and bone cement insertion, followed by cement extraction and autogenous bone grafting. Results: Complete infection resolution was achieved for all patients, and radiological evidence of bone union was observed within an average of 46.93 days. Bone defects measured between 10 and 30 mm; most patients received cancellous bone grafts, although cortico-cancellous grafts were utilized in four cases. Functional outcomes, evaluated through the Quick disabilities of the arm, shoulder, and hand questionnaire, demonstrated marked improvement (49.78→10.33). The mean total active motion of the affected digits was 82.14%, with a majority attaining functional use. No cases of recurrent infection were identified, and the staged surgical method demonstrated effectiveness for digit preservation, including those with bone loss exceeding 10 mm. Conclusion: The authors suggest antibiotic-loaded bone cement insertion followed by autogenous iliac bone grafting can be a highly reliable and reproducible intervention for subacute/chronic phalangeal OM. We advocate this approach as a treatment option for phalangeal OM.