Tubercular Osteomyelitis of Metacarpals and Phalanges in Children

Agarwal, Anil; Qureshi, Nadeem Akhtar; Kumar, Pawan; Khan, Shariq

doi:10.1142/s0218810411005011

Cited by 8 publications

(23 citation statements)

References 18 publications

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“…Although there are a few series of studies on wrist and hand TB among adults, none describes the disease in the paediatric population [4,5]. Skeletal TB may behave differently in this age group compared with the adult population [6]. The paucity of studies from different countries coupled with a difficulty in diagnosis resulting in major morbidity led us to carry out work on this topic.…”

Section: Introductionmentioning

confidence: 99%

Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients

Prakash

Mehtani

2017

Journal of Pediatric Orthopaedics B

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Skeletal tuberculosis (TB) of the hand and wrist is rare, accounting for less than 1% of all osteoarticular TB. Although rare, TB of the hand and wrist is a cause of major morbidity. A common feature among all available reports on TB of the hand and wrist was a delay in diagnosis, causing residual stiffness and pain after treatment. Minimal initial symptoms, rarity of the lesion and ability of wrist TB to mimic more common pathologies account for the delay. Skeletal TB may behave differently in this age compared with the adult population. Further, the disease may affect the growing bone, causing residual deformities. The paucity of studies from different countries, coupled with a difficulty in diagnosis resulting in major morbidity, led us to carry out a study on this topic. A total of 44 patients with skeletal lesions in the hand and wrist were studied. The diagnosis was confirmed by biopsy. Patients were started on multidrug antitubercular treatment (ATT). Those not responding were scheduled for debridement. All patients were assessed using the Green O'Brian scoring system. All these patients were studied separately for clinical presentation, nutritional status (Rainey-Mcdonald nutritional index), time from onset of symptoms to presentation, treatment required, prognosis and complications. The proximal phalanx of the fourth digit and the metacarpal of the fifth digit were the most commonly involved bones in our series, with five cases of each. The capitate was the most common carpal bone, followed by the lunate. The duration of symptoms ranged from 5 weeks to 24 weeks (mean: 7.6 weeks). Most of these patients presented with complaints of pain, followed by swelling. 13 patients did not respond favourably to ATT over an 8-week period and were scheduled for surgery. Three of these patients had multidrug resistance. There was one case of a pathological fracture in our series and seven cases of arthritis/residual significant pain at the end of follow-up. For all the other patients, the results were excellent. A very high index of suspicion, MRI and early biopsy are required for a timely diagnosis of skeletal TB of the hand and wrist. Early commencement of ATT was the most important factor for good results. The possibility of multidrug resistance should be kept in mind for patients not responding to treatment.

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Section: Introductionmentioning

confidence: 99%

Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients

Prakash

Mehtani

2017

Journal of Pediatric Orthopaedics B

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“…This mild presentation of the disease condition makes delay in diagnosis. [8][9][10] Unlike in developed world, due to the rarity of the tubercular infection there is lot of diagnostic dilemma particularly when the presentation is unusual; but in countries where tuberculosis is endemic tubercular dactylitis should be one of the probable differential diagnosis in any osseous pathology of hands and feet. 8,10 Blood examination may show mild increase in ESR but rest of the parameters are usually normal x-ray may give a clue to the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Tubercular dactylitis in a 65 year old female: a rare case report

et al. 2017

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<p class="abstract"><span lang="EN-IN">Tubercular dactylitis is defined as tubercular infection of the metacarpals, metatarsals and phalanges. It is a rare form of extra pulmonary tuberculosis. Bones of the hand are more commonly affected than the bones of the feet. Tubercular dactylitis is common in children and children below 6 year of age accounts for 85% of cases. The diagnosis is usually by a combination of clinical suspicion coupled with radiological investigation and confirmation by biopsy. We hereby present a case report of tubercular dactylitis in a 65 year old female which was treated by antitubercular therapy.</span></p>

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“…Sclerosis may be seen in long standing cases. 11,12,13,15,16 Tubercular osteomyelitis of metacarpals and phalanges appear to be a sequential manifestation of the disease process, and 3 radiological stages has been described. 15 In our case, left second metacarpal was at stage three and right second metatarsal was at stage two, which might be because of simultaneous infiltration of the bones by tubercular bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…This mild presentation of the disease condition makes diagnosis delay. 9,13,14,15,16,18,20,26,28 Sometimes tubercular osteomyelitis can be masked by pyogenic osteomyelitis.23 Unlike in developed part of the world where there is lot of diagnostic dilemma due to rarity of the tubercular infection particularly when the presentation is unusual; tubercular dactylitis should be one of the probable differential diagnosis in any osseous pathology of hands and feet, particularly in countries where tuberculosis is endemic. 5,6,7,8,10,12,13,14,16 Blood examination may show mild increase in erythrocyte sedimentation rate.13 Mantaoux test is usually positive.…”

Section: Discussionmentioning

confidence: 99%

“…13,14,15,16,20 However, there are recommendations that debridement of the lesion can be helpful both for prompt tissue diagnosis and rapid recovery with anti-tubercular treatment. 3,8,9,17,28 This was supported by our experience in our case, there was rapid recovery with anti-tubercular treatment after drainage of pus and granulation tissues.…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Tubercular Osteomyelitis Involving Bilateral Symmetrical Second Metacarpals

Pokharel

2013

Journal of Institute of Medicine

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Skeletal tuberculosis involving small bones of the hand is less common.We report a case, 6 year old boy, of bilateral symmetrical tubercular osteomyelitis of second metacarpals. He presented with gradually increasing swellings over bilateral hands over duration of one month. There was no other significant history relating to tuberculosis. Hand X-rays showed expansive lesions of bilateral second metacarpals. Thick pus and necrotic tissue was removed from both the swelling and from the bone. Presence of typical tubercular granuloma in the histopathological examination confirmed the diagnosis. The boy was treated with antitubercular drugs and improved after completion of anti-tubercular treatment.Tuberculosis can present in different ways, and should be kept as one of the possible diagnosis of several bony pathologies including metacarpals and phalanges, especially in this part of the world where tuberculosis endemic.

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Tubercular Osteomyelitis of Metacarpals and Phalanges in Children

Cited by 8 publications

References 18 publications

Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients

Hand and wrist tuberculosis in paediatric patients – our experience in 44 patients

Tubercular dactylitis in a 65 year old female: a rare case report

Multifocal Tubercular Osteomyelitis Involving Bilateral Symmetrical Second Metacarpals

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