Clinical Example: Bone graft psoriatic acro osteolysis

This elderly patient presented with a progressive thumbnail deformity. A history of psoriasis was revealed only postoperatively...
 
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Plain films showed resorption of the distal two thirds of the distal phalanx:
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Comparison views of the opposite side:
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MRI demonstrated ill defined soft tissue replacement of the majority of the distal phalanx:
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With contrast enhancement of the transformed area:
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Exploration revealed no discrete  tumor, and a nondiagnostic frozen section. Because of diagnostic uncertainty and in order to avoid intraoperative cross contamination, a cancellous freeze dried allograft was used as a terminal graft: 
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This incorporated, with some terminal resorption:
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acro osteolysis
psoriatic osteolysis
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