Clinical Features and Treatment Outcome of Wrist Tuberculosis in Adult- A Retrospective Study of 84 Consecutive Cases with Minimum of 2 Years Follow Up

Abstract Background Wrist tuberculosis (TB) is a rare disease which may result in residual deformity, pain or stiffness even after proper antitubercular chemotherapy (ATT) and surgical intervention. The aim of our study is to present clinical features and functional outcome of wrist TB in a consecutive series of 84 adult patients with a minimum of 2 years follow up. Methods Clinical feature and treatment outcomes of 84 consecutive adult patients with wrist TB from January 2003 to June 2018 includes 45 men and 39 women, with a mean age of 46.8 years (18–84) were retrospectively analyzed. Data were collected on participant’s demographic details. The primary outcome measures were QuickDASH score, grip strength, Visual Analogue Scale (VAS) and PRWHE. Secondary outcomes include health related quality of life was evaluated using the EuroQol five-dimension five-level (EQ-5D-5L) ,assessment and postoperative complications of patients underwent operation were also recorded. Results All 84 patients with an average follow up of 50.8 (24–105) months. The mean duration of symptoms before treatment was 10.5 months (2–21 ). There were 27 patients with bony and 57 with primarily soft-tissue involvement based on preoperative evaluation of plain radiographies and MRI. 33 patients were treated with ATT and 51 patients were treated with surgical treatment combined with ATT.Among them, 13 patients (15.5%) underwent incision and decompression, 14 patients (16.7%) underwent wrist synovectomy, 13 patients (15.5%) underwent wrist joint fusion by plate fixation, and 11 patients (13.1%) underwent wrist joint fusion by external fixation. At last clinical visit, the QuickDASH, PRWHE score of all patients decreased significantly, the VAS, EQ-5D-5L utility index, EQ-VAS score increased remarkably, and the grip strength improved significantly. All patients indicated good wrist recovery at last follow up, and the treatment described above achieved satisfactory clinical outcomes. Conclusion The onset of wrist TB is insidious; early diagnosis, good patient compliance, and surgery combined with ATT are crucial steps for treatment of wrist TB, and also essential for the patient's postoperative recovery. Wrist arthrodesis has achieved satisfactory results in the treatment of severe wrist TB.