What question did this study set out to answer?

This study aims to investigate management strategies and outcomes of acute hand and wrist infections in low- and middle-income countries.

April 11, 2026Bone & Joint Open0 citationsOpen Access

Management and outcomes of acute hand and wrist infections in low- and middle-income countries

ASAbigail ShawNuffield Orthopaedic Centre ASAbhishek SahaDelft University of Technology KDKian DaneshiCentre for Sustainable Energy

Key Points

This study aims to investigate management strategies and outcomes of acute hand and wrist infections in low- and middle-income countries.
Conducted a systematic review and meta-analysis following PRISMA guidelines.
Included studies of acute bacterial hand and wrist infections in LMICs that reported at least one outcome.
Evaluated primary outcomes of amputation risk and mortality.
Screened 18,208 abstracts, with 39 studies involving 4,130 patients included.
Meta-analysis revealed a 26.1% risk of amputation among patients, rising to 32.7% for diabetic individuals.
Overall mortality risk was reported at 2.8%, with most studies having moderate to high risk of bias.

Abstract

Aims Acute hand and wrist infections can be devastating, with a substantial burden in low- and middle-income countries (LMICs) compared with high-income countries. Access to treatment, particularly surgery, can be limited. This study aimed to determine the management and outcomes of hand and wrist infections in LMICs. Methods A PRISMA-compliant systematic review and meta-analysis was conducted (Prospective Register of Systematic Reviews (PROSPERO) CRD420250631145) within MEDLINE, EMBASE, Global Health, Global Index Medicus, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science from database inception to December 2024. Studies of acute bacterial hand and wrist infections managed in LMICs, reporting at least one outcome, were included. Primary outcomes were risk of amputation and mortality. Results Of 18,208 abstracts screened, 39 full-text studies with 4,130 patients were included. These were mostly retrospective case series, from Africa and Asia. Mean age was 45.0 years (SD 9.3), with a male preponderance (63.3%, n = 1,804). Over half of studies (n = 22) focused on diabetic hand and wrist infections. Deep space infections were the most common infection. Mean delay to presentation was 11.8 days (SD 6.1) and surgery was required for source control in 89.4% of patients (n = 3,693). Mean length of stay for admitted patients was 12.2 days (SD 14.1). Meta-analysis demonstrated a 26.1% (95% CI 16.8 to 36.4) risk of amputation (31 studies), rising to 32.7% (95% CI 21.3 to 45.0) in studies of diabetic patients. Mortality risk was 2.8% (95% CI 1.0 to 5.3; 18 studies). Functional and socioeconomic outcomes were rarely reported. Risk of bias was assessed as moderate or high in 85% of studies (n = 33). Conclusion Hand and wrist infections in LMICs often present late and have high rates of amputation and death, particularly among diabetic patients. Future research is needed to mitigate delayed presentation and develop interventions focused on saving life and limb. Cite this article: Bone Jt Open 2026;7(4):519–530.

KI fragen

Bookmark

View Full Paper