Management of Osteomyelitis of the Distal Forearm and Wrist With Function-Preserving Debridement

Purpose: Osteomyelitis of the wrist and distal forearm is rare but functionally devastating because of the extensive debridement needed for infection control and reconstructive surgery needed to regain function. Management guidelines and outcomes are poorly defined and often default to amputation as a last resort strategy for infection control. In this study, we present a series of wrist and distal forearm osteomyelitis patients managed with antibiotics and debridement, with minimal reconstruction in select cases, to help guide decisions on management and prognosis. Methods: Patients over the age of 18 years diagnosed with wrist and/or distal forearm osteomyelitis were identified at a single institution between the years 2013 and 2023. A retrospective review was performed to identify demographics, infection characteristics, treatment strategies, and outcomes. Statistical analysis was performed via GraphPad. Results: Eleven cases of distal forearm and wrist osteomyelitis were identified. Of those, 55% had primarily distal forearm osteomyelitis of the radius and ulna, and 45% had carpal or metacarpal involvement. Most patients had postoperative infection of hardware. All but one patient required surgical debridement with hardware removal and five patients required serial debridements. No patients required amputation. Antibiotic spacers were rarely used. Patients reported residual pain and stiffness in the wrist, and salvage procedures included wrist arthrodesis and tendon transfers. Conclusions: Osteomyelitis of the distal forearm and carpus in this cohort is most commonly because of postoperative infection from contaminated hardware. These patients require aggressive debridement for infection control including frequent bony resection with salvage via arthrodesis, but amputation can often be avoided. Type of study/level of evidence: Therapeutic IV.