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Surgical rehabilitation for correction of severe flexion contracture of the proximal interphalangeal joint by modified Ilizarov method

(p<0.001). WBC values were also higher in mimickers, albeit not significantly. No statistically significant differences were found for the other inflammatory markers between infected patients and mimickers (Table 1). Sixty-one infected patients (46%) showed mild elevation of CRP (>6 to <40 mg/L), 21 (16%) showed moderate elevation (>40 to <100 mg/L) and nine (7%) showed marked elevation (>100 mg/L). Patients with infection-mimicking diseases showed mild elevation of CRP in nine cases (33%), moderate elevation in nine (33%) cases and marked elevation in nine (33%) cases. An elevated CRP was observed in 30 (48%) infections in Zone 1 (distal) and in 61 (87%) in the zone proximal to the digits. Schmidt-Matthiesen and Oremek (1990) reported CRP sensitivity levels of 0.6–0.9 and specificity levels of 0.8–0.9 in the diagnosis of hand infections. In our study, the sensitivity of CRP was 0.69. The sensitivity of all other inflammation markers was 0.5 or lower. PCT appears to be of no diagnostic value in hand infections. The specificity of all inflammation markers was inadequate for diagnosis. All mimickers showed elevated CRP values; 66% had moderately or markedly elevated CRP values, which resulted in a specificity of zero for CRP in our study. Only 62% of patients with infections showed mildly or moderately elevated CRP values. Six out of nine infected patients with markedly elevated CRP values had additional foci of infection or lymphangitis. This may explain the high CRP values. In our study, just below 50% of patients with finger infections (zone 1) had elevated CRP values. However, physiological inflammation marker values do not exclude the presence of an infection, especially of the fingers. Our study suggests that crystal arthropathies may influence the CRP value more than local infections owing to their systemic pathomechanism and their highly inflammatory characteristic. At a cut-off level of 40 mg/L, the sensitivity and specificity for CRP in our patients were 0.77 and 0.65, respectively. Thus, CRP values above the cut-off level may indicate the presence of a disorder that mimics an infection. Joint aspiration may be justified to exclude the presence of crystals, especially in patients with mono-arthritic findings and a positive medical history. WBC, ESR and PCT do not need to be determined. For organizational reasons this study was not blinded, which had a direct effect on the level of evidence. Our findings therefore need confirmation in further studies.