Thorn-induced osteomyelitis of the metacarpal of the index finger in a paediatric patient

We report a case of a girl in mid childhood, who presented with a 2-month history of painless swelling on the dorsum of her right hand, with an unclear history of fall while playing, around 4 months prior to presentation to us. The child remained asymptomatic during the interim period. Radiographs and ultrasonography were suggestive of osteomyelitis of the index finger metacarpal of the right hand. However, routine blood tests and inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein were normal. She was provisionally diagnosed as a case of chronic osteomyelitis of the index finger metacarpal of the right hand. Surgical exploration showed the presence of an intramedullary foreign body (thorn), along with associated changes in the bone, periosteum and tendon sheath. Removal of the thorn and administration of appropriate antibiotics resulted in complete recovery.This case report highlights the importance of carefully evaluating subtle or non-specific patient histories. It also emphasises the need to consider thorn-induced osteomyelitis as a differential diagnosis, particularly in paediatric patients belonging to rural areas presenting with osteomyelitis of the hand or foot, even in the absence of a clear history of trauma or abnormal blood parameters.