Chronic Osteomyelitis of the Thumb Treated with Surgical Debridement, Antibiotic Cement Beads, and K-Wire Stabilization: A Case Report.
- 1Department of Hand and Microsurgery, Krisha Hospital, Ahmedabad, Gujarat, India.
Abstract
Chronic osteomyelitis of the thumb is an uncommon but potentially disabling condition that can result in persistent pain, swelling, restricted motion, bone destruction, and functional impairment. Successful treatment generally requires adequate removal of infected and necrotic tissue, microbiological and histopathological assessment, and appropriate stabilization when structural integrity is compromised. An 18-year-old male presented with a 2-3-month history of pain and swelling of the right thumb, associated with severe swelling, loss of thumb movement, and discharge for approximately 2 weeks. Pre-operative clinical photographs demonstrated marked swelling and a localized lesion over the thumb. Radiographic evaluation demonstrated destructive changes involving the thumb with associated soft-tissue swelling. The patient underwent surgical debridement of infected and necrotic soft tissue and bone, excisional biopsy, microbiological investigation, local antibiotic cement bead placement, and K-wire stabilization. Postoperatively, the thumb was immobilized in a slab, with planned K-wire removal after 4-6 weeks and physiotherapy after 2 months. Histopathological examination demonstrated caseating granulomatous inflammation with epithelioid cells and Langhans-type giant cells. Although Ziehl-Neelsen staining was negative, tissue GeneXpert detected Mycobacterium tuberculosis at a very low level with no rifampicin resistance. Routine bacterial culture additionally demonstrated scanty methicillin-resistant coagulase-negative Staphylococcus. This case demonstrates the importance of aggressive surgical management in chronic thumb osteomyelitis. Thorough debridement of infected and necrotic tissue, combined with local antibiotic delivery and stabilization of the affected bone, represents an important limb-preserving treatment strategy.
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BibTeX
@article{maheshwari2026chronic,
title = {{Chronic Osteomyelitis of the Thumb Treated with Surgical Debridement, Antibiotic Cement Beads, and K-Wire Stabilization: A Case Report.}},
author = {Karn Maheshwari and Poojan Parmar and Happy Sathwara and Hiren Sathawara and Jaimin Vaishnav},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8454},
url = {https://europepmc.org/article/MED/42997086},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Chronic Osteomyelitis of the Thumb Treated with Surgical Debridement, Antibiotic Cement Beads, and K-Wire Stabilization: A Case Report.
AU - Karn Maheshwari
AU - Poojan Parmar
AU - Happy Sathwara
AU - Hiren Sathawara
AU - Jaimin Vaishnav
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8454
UR - https://europepmc.org/article/MED/42997086
AB - Chronic osteomyelitis of the thumb is an uncommon but potentially disabling condition that can result in persistent pain, swelling, restricted motion, bone destruction, and functional impairment. Successful treatment generally requires adequate removal of infected and necrotic tissue, microbiological and histopathological assessment, and appropriate stabilization when structural integrity is compromised. An 18-year-old male presented with a 2-3-month history of pain and swelling of the right thumb, associated with severe swelling, loss of thumb movement, and discharge for approximately 2 weeks. Pre-operative clinical photographs demonstrated marked swelling and a localized lesion over the thumb. Radiographic evaluation demonstrated destructive changes involving the thumb with associated soft-tissue swelling. The patient underwent surgical debridement of infected and necrotic soft tissue and bone, excisional biopsy, microbiological investigation, local antibiotic cement bead placement, and K-wire stabilization. Postoperatively, the thumb was immobilized in a slab, with planned K-wire removal after 4-6 weeks and physiotherapy after 2 months. Histopathological examination demonstrated caseating granulomatous inflammation with epithelioid cells and Langhans-type giant cells. Although Ziehl-Neelsen staining was negative, tissue GeneXpert detected Mycobacterium tuberculosis at a very low level with no rifampicin resistance. Routine bacterial culture additionally demonstrated scanty methicillin-resistant coagulase-negative Staphylococcus. This case demonstrates the importance of aggressive surgical management in chronic thumb osteomyelitis. Thorough debridement of infected and necrotic tissue, combined with local antibiotic delivery and stabilization of the affected bone, represents an important limb-preserving treatment strategy.
SN - 2250-0685
SN - 2321-3817
ER -