Skeletal tuberculosis of the wrist and hand: a study of 27 cases

The 27 cases of skeletal tuberculosis in the hand and wrist reported represented 6.9% of the skeletal tuberculosis seen at our hospital and 32% of the skeletal tuberculosis found in the upper extremity. In a majority of these patients a single bone or joint was involved and 18.5% of the patients had bone and/or joint involvement outside the hand. Pulmonary tuberculosis was present in 10.7% of these cases. The clinical picture of tuberculosis is similar to that of other infections and tumorous conditions, but a history of absent bacille Calmette Guérin protection and positive tine test should arouse one's suspicion to the condition. Eight-six percent of our patients had x-ray findings that included bone atrophy, bone or joint destruction with discrete periostitis, or the presence of the typical spina ventosa. We found no case of resistance to various combinations of the usual drugs in any patients. Supportive orthopaedic splints were used over short periods (3 months) and surgery was used for diagnostic purposes (biopsies) and in treatment by fusion of two wrists in this patient series. Finger joint involvement responded satisfactorily to drug and conservative orthopaedic treatment and in no case were these joints fused or replaced by a prosthesis.