Purulent infection in the third finger with associated osteomyelitis.

To cite: Couto-Gonzalez I, Brea-García B, TaboadaSuárez A. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2012008476 DESCRIPTION An 82-year-old woman was referred to our department due to swelling, warmth and severe functional impairment in the third finger of her right hand. She had a medical history of arterial hypertension, diabetes mellitus and atrial fibrillation. After physical examination, severe tumefaction of the finger was evident (figure 1). Spontaneous flexion of the distal interphalangeal joint with full incompetence to active extension and severe pain upon passive extension were noted. Pain was experienced with flexo-extension movements in the proximal interphalangeal joint and increased when the volar aspect of the finger was pressed above the flexor tendon sheath. The patient reported an accidental prick with a needle in the volar aspect of the distal phalanx (DP) almost 2 months ago. Inflammation and purulent exudate occurred over the following 2 weeks but the patient did not seek medical counsel. The patient’s temperature was 36.3°C and blood analysis revealed mild leucocytosis (12 500 cells/dl). Plain radiography of the affected finger showed a type-IV osteomyelitis with full-thickness bone sequestrum of the DP and the distal third of the middle phalanx (MP; figure 2). Complete