Clinical Example: Rheumatoid MCP implant infections seeded from chronic distant abscess

Infections seeding implants are uncommon. In this case, a patient with rheumatoid arthritis and silastic metacarpophalangeal joint replacements developed infections of her implants associated with a calf abscess developing from a puncture wound of the sole of the foot. This patient had the implant surgery done elsewhere, and had done well for several years until a few weeks after she stepped on something sharp and developed a minor infection in the foot, which her doctor treated with antibiotics. Weeks later, she developed swelling, redness, and worsening pain in all of her hand joint replacements.

 
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The old puncture wound.
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Right hand, bulging MCP arthroplasty abscesses.
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Left hand, same.
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Staph drained from all implants.
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Treated with continuous irrigation of all medullary canals following implant removal.
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Continuous suction within the bandage helped prevent a continuously dripping bandage.
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Preop films.
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And the culprit, which turned out to be a deep lower leg abscess which grew out the same bacteria as the implants.
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Incision and debridement of the calf.
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