International Journal of Research in Orthopaedics | May-June 2023 | Vol 9 | Issue 3 Page 607 International Journal of Research in Orthopaedics Patil TC et al. Int J Res Orthop. 2023 May;9(3):607-610 http://www.ijoro.org Case Report Two rare cases of management of proximal phalanx spina ventosa Neetin P. Mahajan, Tushar C. Patil*, Sunny Sangma, Kartik P. Pande INTRODUCTION Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. 1 Tuberculosis (TB) is one the most common infections of the developing countries with prevalence of extrapulmonary TB being 15-25%. Out of these skeletal TB cases accounted for 5%, of which spine TB is most common whereas tubercular dactilitis is considered of rare occurrence being upto 4%. 2 There is frequent involvement of long bones with diffuse sclerosis of short tubular bones of hand and feet. 3 The diagnosis is often delayed owing to its insidious onset and gradual progress due to paucibacillary nature of organism. It can be often be confused with tumours which thus necessitate histopathological testing. In majority of cases, there is no evidence of any concomitant dormant or active tubercular foci elsewhere in the body. In children, it usually occurs after an initial untreated tubercular pulmonary infection and are located in peripheral bone, in contrast to adults. 2,3 Initial plain radiographs are usually suggestive of simple cortical demineralization and osteoporosis with absence of periosteal reaction. 2 The lack of awareness among poor socio-economic strata with inadequate rapid diagnostic techniques and occasional inconclusive microbiological and histopathological reports delays the diagnosis even further. Long standing neglected cases then develop joint instability with discharging sinus formation. 1 CASE REPORT Case 1 A 10 years old female brought by parents to OPD with pain and swelling of left middle finger proximal phalanx since ABSTRACT Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. Here we presented two rare cases of spina ventosa in a 10 years old female and a 16 years old male patients. In both cases there was swelling of digits with stiffness. The radiographs were suggestive of chronic osteolytic infection with cortical destruction and diffuse sclerosis. We managed them with adequate surgical debridement, splintage and anti-tubercular therapy with good functional recovery. Spina ventosa or tubercular dactylitis is a rare condition and is often missed on diagnosis due to vague non-specific presentation, unavailability of rapid diagnostic tests and can be confused with other mimicking diseases. Any swelling over small tubular bones of hand or feet should raise the suspicion of spina ventosa, especially in endemic countries for tuberculosis. In neglected chronic infections, surgical debridement, curettage and splintage followed by anti-tubercular therapy based on histo-pathological reports is the treatment of choice with high protein diet and vitamin D supplementation ensures good outcome. Keywords: Spina ventosa, Tubercular dactylitis, Tuberculosis, Tubular bones, Tubercular osteomyelitis Department Orthopaedics, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India Received: 22 February 2023 Revised: 01 March 2023 Accepted: 04 March 2023 *Correspondence: Dr. Tushar C. Patil, E-mail: tushar6919@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20231192