Risk factors for surgical revision and functional outcomes in 121 Pasteurella hand infections

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INTRODUCTION: Pasteurella spp. are frequently implicated in animal-related hand infections, often presenting with severe local symptoms. Given their frequency and potential severity, we conducted a retrospective study to identify the incidence and risk factors for surgical revision and to evaluate long-term functional outcomes. METHODS: This single-center retrospective analytical study included patients operated on in a hand emergency center between November 2011 and June 2024. Eligible patients had deep structural involvement of the hand and intraoperative bacteriological samples positive for Pasteurella spp. Functional outcomes were assessed by telephone or videoconference. Univariate analysis was performed using chi-square or Fisher's exact tests, with odds ratios (ORs) calculated for each risk factor. RESULTS: 121 patients were included. The median interval between surgery and follow-up was 21 months (range 2-152). Fifteen patients (12.4%) required surgical revision. Significant risk factors for revision were diabetes (OR 3.9), septic arthritis (OR 4.0), initial management delay >72 h (OR 4.4), and age 45-65 years (OR 4.6). Functional assessment showed a significant reduction in total active motion of the long fingers and thumb compared with the contralateral side, while the Kapandji score was not significantly affected. Fourteen percent of patients reported mechanical pain and 26% neuropathic pain, although all resumed their usual activities satisfactorily. CONCLUSION: This study identified four risk factors for emergency surgical revision in Pasteurella spp. hand infections. Functional outcomes demonstrated significant reductions in total active motion of the fingers, with a notable prevalence of residual neuropathic (26.4%) and mechanical pain (14%). Tailoring management to these factors may improve outcomes, pending confirmation by multivariate analysis.

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