Management of thumb chronic osteomyelitis with extrusion of the proximal phalanx in a low-resource setting

Abstract

Objective: We report the case of a 14-year-old girl that presented chronic osteomyelitis with extrusion of the proximal phalanx, after a traumatic event three months before, in the rural setting of Djoum, Cameroon. Massive defects of the proximal phalanx of the thumb are uncommon, mostly associated with traumatic amputations or tumors. The aim of this study is to describe our experience in the management of this injury in a low resource center and its mid-term clinical results. Methods: The presence of an active infection and the lack of technological support determined our treatment choice. Extensive debridement, metacarpophalangeal arthrodesis with 2 Kirschner wires and first web space deepening were performed. Rifampicin and trimethoprim-sulfamethoxazole were prescribed empirically for four months. Results: At 6-month-following-up the patient was pain-free. Complete arthrodesis of the distal phalanx and first metacarpal was confirmed in clinical assessment. The thumb was slightly pronated, and it permitted good opposability against second, third and fourth fingers. The sensitivity of the thumb tip kept intact. The overall function was rather good, with a QuickDASH score of 18 at the two-year follow-up visit. She was satisfied with final pinch ability and had returned to her normal activities. Conclusions: We suggest that in a disadvantaged rural environment, metacarpophalangeal arthrodesis associated to first web space deepening may be a reliable treatment for a massive defect of the proximal phalanx of the thumb due to chronic osteomyelitis achieving a satisfactory hand function.