There are erosive changes in the distal phalanx of the fifth finger, with loss of the overlying cortex. This is suspicious for osteomyelitis.
While plain films will have non-specific changes early in the disease process, osseous changes will often be visible after 10 to 14 days. Most occurrences of osteomyelitis after a trauma are from a contiguous spread from an adjacent soft-tissue infection.
This patient was admitted and found to have a small abscess that was cultured to grow methicillin-resistant Staphylococcus aureus (MRSA). He was started on IV vancomycin and discharged home with PO trimethoprim/sulfamethoxazole for six weeks.
Case presented by Sara A. Lolar, PA-C, Detroit Receiving Hospital Emergency Department; Wayne State University Physician Assistant Program, Detroit, MI.
[taq_review]