CASE REPORT
A 44-year-old female patient visited the outpatient clinic with pain at the left middle phalanx of the second finger because she was bitten by a cat at home two days before the visit. The patient had a history of hepatitis C. She had no other special history or medical disease. On physical examination performed at the time of the first visit, mild swelling and redness were observed in the middle phalanx of the left second finger and approximately 1 mm of wounds presumed to be cat tooth marks were observed on the volar and dorsal side. As it was judged to be a very minor wound, no special suture except simple dressing was performed. Oral antibiotics were prescribed. After one week, the wound recovered without any particular problem. However, edema, redness, and mild pain persisted. Although there was no serious complaint of pain, edema and redness continued until 2 months after the injury. Thus, blood tests and simple radiographic examination were performed again. White blood cell count, Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were in their normal ranges. However, an osteolytic lesion was observed in the middle phalanx of the second finger on simple radiographic (X-ray) examination (Figure 1). This lesion had irregular borders with a local defect, especially in the anterior cortical bone. Subsequent MRI showed an abscess measuring 0.3 X 0.3cm in the distal middle phalanx with surrounding bone edema and soft tissue inflammation (Figure 2).
The authors diagnosed osteomyelitis and decided to operate. First, a zigzag incision was made in the volar side of the second finger. No particular infection was found in the subcutaneous layer. However, when the A4 pulley was incised and opened, the infected granulation tissue was easily identified along the flexor tendon. The synovial membrane of the flexor tendon had a defect presumably caused by the cat’s tooth (Figure 3A). Under the flexor tendon, the anterior cortex of the metacarpal bone was penetrated and the medullary cavity was exposed (Figure 3B) Debridement of infected tissue surrounding the metacarpophalangeal joint, Gram-staining, and culture were done. The A4 pulley was then reconstructed and primary sutures were performed. (Figure 3C). After the surgery, the splint was applied until the wound was completely healed for two weeks. After the suture was removed, limited joint movement was started. Range of motion exercise was started after all stitches were removed. For antibiotics, second-generation cephalosporin was administered intravenously up to two weeks after surgery. Oral antibiotics were then administered for four weeks thereafter. In the culture test performed for samples collected during surgery, no particular strain was identified even after culturing for more than four weeks. At 1-year follow-up, radiographic examination showed that the previous bone defect had recovered (Figure 4) and joint motion was restored to the normal range. There were no signs of infection such as edema or fever. The metacarpophalangeal and surrounding infected tissues were subjected to debridement, washing, and bacterial culture.
중수지절 및 주변의 감염된 조직은 괴사조직 제거, 세척 및 세균 배양을 받았다.
The debridement and lavage And, bacterial culture were performed in the median phalanges and surrounding tissue infections.
괴사조직 제거 및 세척 그리고 정중 지골 및 주변 조직 감염에서 세균 배양을 시행하였다.
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After that, the A4 trochle was reconstructed and primary sutures were performed. (Fig. 7) After surgery, the splint was fixed until the wound was completely healed for 2 weeks, the suture was removed, and limited joint movement was started.
그 후 A4 trochle을 재건하고 1차 봉합을 시행하였다. (그림 7) 수술 후 상처가 완전히 아물 때까지 2주간 부목을 고정하고 봉합사를 제거한 후 관절의 움직임이 제한되기 시작하였다.
Was rebuilt after the A4 pulley and primary repair was performed (Figure 7) was fixed splint until the wound is completely restored two weeks after surgery to remove sutures and start a limited range of motion.
A4 풀리와 1차 수리 후 재건되었고(그림 7) 봉합사를 제거하고 제한된 가동 범위를 시작하는 수술 후 상처가 완전히 회복될 때까지 부목을 고정했습니다(그림 7).
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For antibiotics, second-generation cephalosporin was administered intravenously up to 2 weeks after surgery, and oral antibiotics were administered for 4 weeks thereafter.
항생제는 수술 후 2주까지 2세대 cephalosporin을 정맥투여하고, 이후 4주간 경구 항생제를 투여하였다.
Intravenous antibiotics were the second-generation cephalosporin to 2 weeks after surgery were administered oral antibiotics for four weeks.
2세대 세팔로스포린 정맥주사용 항생제는 수술 후 2주까지 4주간 경구 항생제를 투여했다.
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In the culture test performed during surgery, bacteria were cultured for more than 4 weeks, but no particular strain was identified.
수술 중 시행한 배양검사에서 4주 이상 균을 배양하였으나 특별한 균주는 확인되지 않았다.
The incubation tests performed during surgery, but the culture for more than four weeks a special bacteria strains were not identified.
수술 중 배양검사를 시행했으나 4주 이상 배양한 결과 특수세균 균주는 확인되지 않았다.
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At 1-year follow-up, radiographic examination showed that the previous bone defect had recovered (Fig. 9,10), and joint motion was restored to the normal range.
1년 추시 시 방사선 검사에서 이전의 골 결손이 회복되었고(Fig. 9,10) 관절 운동이 정상 범위로 회복되었다.
1 year follow-up was observed on the previous radiological findings of bone defects is restored observed (Figure 9,10) motion was restored to the normal range.
1년 추시에서 관찰된 이전의 방사선 소견에서 골결손이 회복되어 관찰되었고(그림 9,10) 운동이 정상 범위로 회복되었다.
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There were no signs of infection such as edema or fever.
부종이나 발열 등의 감염 징후는 없었다.
Swelling, infection did not occur findings such as hot flushes.
종기, 감염은 안면 홍조 등의 소견은 발생하지 않았습니다.
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