Transform osteomyelitis of the phalanges
Courtesy of Richard Lang BSc (Hons) MSc FRCPodS & Jason Nandlal BSc (Hons) MSc FRCPods, Podiatric Surgeon & Consultant Podiatric Surgeon, Bishop’s Stortford, Hertfordshire, UK
63-year-old male, with a history of type 1 diabetes, psoriatic arthritis, ischemic heart disease and myocardial infarction.
The patient’s right hallux and 2nd toe exhibited probing to bone breakdown with radiographic evidence of osteomyelitis. Tissue cultures grew Staphylococcus aureus. He was prescribed 8 weeks of IV and oral antibiotics, however, the wound deteriorated.
The patient was diagnosed with R1st osteomyelitis of proximal phalanx and R2nd osteomyelitis of intermediate phalanx. The 2nd terminal phalanx had previously been removed in clinic during routine wound care. Despite the levels of infection, the decision was made to try and preserve the digits using genex. The infected bone was surgically resected back to healthy bleeding bone. genex was used to fill the resulting voids. The material was moulded into phalangeal shapes using two different-sized syringes. Once the genex had set, it was implanted into the resected cavities followed by primary skin closure. After 2 weeks, the skin had healed.
This technique successfully eradicated the infected tissue and mitigated the risk of recurrence, while allowing fibrous and bony growth within these gaps to provide ongoing digital stability which will aid function and gait.
At 11 months postoperatively, there have been no recurrent infections in either toe. Both the first and second toes demonstrate palpable internal stability. As anticipated, the hallux has undergone slight shortening; however, it remains functionally stable. Importantly, there are no clinical signs of transfer loading or compensatory issues, indicating a successful and durable surgical outcome.
Listed below are 4 of the most relevant articles for this piece but there is much more to explore on our Library page.
Explore Library