Retrospective study on treatment outcomes of two-stage bone grafting vs. amputation in distal phalangeal osteomyelitis.

Abstract

This study aims to evaluate the outcomes of two-stage bone grafting versus amputation for the treatment of distal phalangeal osteomyelitis. We conducted a retrospective multicenter study of 102 patients with distal phalangeal osteomyelitis, of whom 53 underwent amputation and 49 underwent two-stage bone grafting. Preoperative characteristics were analyzed, including sex, age, BMI, prevalence of diabetes and osteoporosis, infection etiology, and fingers involved. The primary endpoint was infection recurrence. Meanwhile, patient-reported outcomes such as hand function and aesthetic satisfaction were also evaluated. Covariance analysis was performed to adjust for the disparity in soft tissue defect scores between the groups. The two treatment groups were initially comparable in most preoperative characteristics; except for a significant difference in soft tissue defect scores (P-value = 0.011). No differences in the occurrence of reinfection were observed between the groups (1/49 in the bone graft group vs. 0/52 in the amputation group, P-value = 0.960). The two-stage bone grafting group reported significantly lower rates of neuropathic pain (2/49 vs. 18/52, P-value < 0.001) and higher aesthetic satisfaction scores (adjusted P-value = 0.007), while the amputation group exhibited lower hand functional scores, especially in fine motor skills (adjusted P-value = 0.031 for lifting large objects, adjusted P-value < 0.001 for the rest). Both surgical treatments showed comparable efficacy in preventing infection recurrence. However, the two-stage bone grafting group demonstrated better patient-reported outcomes in terms of hand function and aesthetic satisfaction and a lower rate of neuropathic pain.