Excision Arthroplasty for First CMC Joint Tuberculous Osteomyelitis

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Extrapulmonary tuberculosis can rarely affect the metacarpals and phalanges, a condition known as tubercular dactylitis.
• This case highlights a rare presentation of tuberculosis in an adult, specifically involving the first metacarpal bone.

Observation:

• A 65-year-old female presented with a 3-month history of progressive pain and swelling at the first metacarpal of the left hand, accompanied by cervical swellings.
• Radiographs revealed a pathological fracture of the first carpo-metacarpal joint (CMCJ), while MRI showed a large lesion with bony erosions.
• Surgical debridement revealed caseous material, and biopsy confirmed tuberculous osteomyelitis.

Findings:

• The patient underwent surgical stabilization of the CMCJ with a Kirschner wire and immobilization.
• Anti-tubercular treatment was initiated, leading to the subsidence of swelling and resolution of cervical lymphadenopathy within one month.
• One-year follow-up showed minimal restriction in hand movement and no pain during daily activities.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of bone lesions, even in adults.
• Early diagnosis and appropriate anti-tubercular treatment are crucial for favorable outcomes in tuberculous osteomyelitis.
• Management involves a combination of surgical intervention for stabilization and medical treatment to eradicate the infection.