Multiple Metacarpal Loss Secondary to Tuberculous Dactylitis: Challenges and Management: A Case Report

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Pediatric Rheumatology

Background:

• Tuberculous dactylitis is uncommon in children over six, typically affecting the index and middle fingers.
• Early diagnosis and treatment are crucial to prevent extensive bone involvement and potential surgical intervention.
• Conservative management is often effective in early stages of tuberculous dactylitis.

Observation:

• An 11-year-old girl presented with extensive tuberculous dactylitis of the 2nd and 3rd metacarpals, unresponsive to 1.5 years of anti-tubercular therapy (ATT).
• The extensive bone involvement and sequestration necessitated staged surgical interventions.
• Surgical management included radical debridement and reconstruction with a non-vascularized fibular strut graft.

Findings:

• The patient required staged surgeries for infection eradication, resulting in the loss of the 2nd and 3rd metacarpals.
• Non-vascularized fibular strut grafting was employed to manage the significant bone defect.
• At two-year follow-up, the graft showed complete incorporation, with satisfactory hand function and ease in daily activities.

Implications:

• Delayed diagnosis of tuberculous dactylitis in children can lead to severe bone destruction requiring complex surgical reconstruction.
• Staged surgical interventions and reconstructive procedures, including bone grafting, can restore function in cases of extensive metacarpal loss.
• This case underscores the importance of timely diagnosis and aggressive management for tuberculous dactylitis to optimize functional outcomes in pediatric patients.