PMC4323402_01
Clinical appearance of right hand at time of initial consultation before incision and drainage. Swelling and erythema of proximal ring finger evident (A) and skin compromise over volar metacarpophalangeal joint crease (B).
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F1
He had a frank abscess overlying the volar fourth metacarpal phalangeal joint (Fig. 1).
Initial posterior-anterior radiograph of the hand following incision and drainage and placement of penrose drain, without reactive changes to the metacarpal and phalanges of the ring finger.
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F2
Radiographs of the right hand demonstrated soft-tissue swelling but no osseous abnormalities (Fig. 2).
Posterior-anterior radiograph of the patient's hand following failure of initial surgical drainage and antibiotic course. Note the diffuse involvement of the ring finger metacarpal and proximal phalanx.
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F3
Upon exploration in the operating room, he was found to have a 5 mL collection of purulent material dorsally, with severe osteomyelitic destruction of the ring finger metacarpal (Fig. 3).
Posterior-anterior radiograph obtained 3 months following presentation. Sclerosis but improved cortical irregularity and contour of ring finger metacarpal and proximal phalanx.
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F4
Follow-up imaging demonstrated irregularity and osteosclerosis of the fourth metacarpal and proximal phalanx (Fig. 4).