Tuberculous dactylitis (Spina ventosa) of proximal phalanx in a 10-year-old girl: A case report

Author(s): Apoorv Kumar, Ajay Kumar SP and Sunil Mannual

Abstract: Tubercular dactylitis, defined as Tubercular osteomyelitis of the short tubular bones of the hand and feet is an uncommon condition seen predominantly in children. The condition is characterised by cystic expansion of the bone due to filling up of the medullary canal with granulation tissue and pus and thinning of the overlying cortex, a condition radiologically termed as ‘spina ventosa’. We report a case of a 10-year-old girl who presented with a painful, slowly progressive swelling of two months’ duration in the index finger of right hand, without any associated history of trauma. The plain radiographs of the hand showed extensive destruction of the proximal phalanx of index finger with thinning of the overlying cortex. Magnetic Resonance Imaging (MRI) showed diffuse enlargement and focal cortical break in the proximal phalanx with thick organised fluid in the medullary canal with a small area of cortical breech. The finger was debrided and the digit stabilised by a K-wire which was removed at three weeks. Biopsy of the debrided material confirmed the clinical diagnosis of Tubercular osteomyelitis. The child was started on anti-tubercular drugs with aggressive mobilisation of the finger at three weeks. At one-year follow-up, the lesion had healed well with functional range of movements of the right index finger.

DOI: https://doi.org/10.22271/ortho.2020.v6.i1l.1941