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Orthopedic Research Online Journal

A Late Presenting Tuberculous Dactylitis Case: Choosing the First Line Medical Treatment or going Ahead with Surgical Debridement?

  • Open or CloseRamin Zargarbashi1, Ehsan Mahmoudi2, Kamand Khalaj3, Alireza Nezami2*, Nesa Milan4

    1Assistant Professor at Orthopedic Department, Tehran University of Medical Sciences, Iran

    2Orthopedic Resident, Tehran University of Medical Sciences, Iran

    3Department of Orthopedic Surgery, Tehran University of Medical Sciences, Iran

    4Research Assistant at Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Iran

    *Corresponding author:Alireza Nezami, Orthopedic Resident, Tehran University of Medical Sciences, Iran

Submission: April 27, 2021Published: May 12, 2021

DOI: 10.31031/OPROJ.2021.08.000683

ISSN : 2576-8875
Volume8 Issue2


Background: Metacarpals and phalanges are rarely affected in extrapulmonary tuberculosis. Tuberculous dactilytis is defined as infection of metacarpals, metatarsals, and phalanges of hands and feet in tuberculosis patients. About 85% of affected people with tubercular dactylitis are younger than 6 years old. As a result of the structure difference between pediatric and adult hand, the disease manifestation and the subsequent course differ substantially.

Case presentation: A 5-year-old female with isolated metacarpal bone involvement admitted to Children medical center Hospital, Tehran ,Iran. The patient history indicated a 6 months antibiotic therapy with no improvement. Based on radiological and sonographical evidences, a surgical intervention was implemented to remove the necrotic tissues and promote vascularization. The patient was discharged and prescribed Ethambutol/isoniazid/pyrazinamide/rifampicin and Vitamin B6 for six months.

Conclusion: The surgical debridement can be suggested as a first line treatment for TB dactilytis, when the bone is severely damaged. In such cases antibiotic therapy should be administered after the surgery.

Keywords: Tuberculous; Dactilytis; Infection; Bone; Debridement; Microbiology; Palliative care

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