A Rare Atraumatic Case of Osteomyelitis of the Carpal Bones

Osteomyelitis of the carpal bones is a rare condition and most commonly occurs in cases of penetrating injury. We report a case of an eleven-month- old boy who presented with a vague history of trauma and not actively using his right hand. No bony changes were noted on the X ray. The Patient was brought in again 5 days later with the same complaints during which examination revealed grossly restricted movement of the right wrist, a repeat X-ray raised the suspicion of some lysis on the hamate which was later confirmed by ultrasound. MRI confirmed osteomyelitis of the distal end of the hamate with additional finding of involvement capitate and fluid in the carpal tunnel. He then underwent right carpal tunnel decompression. Blood cultures grew gram-negative coccobacillus. However, there was no growth from the sample from the wrist. He was treated with IV antibiotics in the hospital which was switched to oral antibiotics. (Total 4 weeks duration). He was followed up for 1 year with repeat x-rays which were normal and he has had a full recovery. This case highlights the importance of considering osteomyelitis as a differential diagnosis even in the absence of trauma.