Case #4 - A Child With Painless Wounds

Janaina Nogueira, MD, Janice Ford, MD, Mary Mancao, MD, Paul Maertens, MD


March 17, 2003


An 8-year-old white girl presented to the emergency department (ED) with a finger injury. Eleven days prior to this, she fell while playing at school and sustained an injury to her right fourth and fifth digits. Nine days prior to the ED visit, she also sustained a burn to her right second digit after touching a curling iron. Local wound care had been performed at home by her mother, and had included daily soaking and wrapping with gauze.

Two days prior to the visit, the girl's fourth finger reportedly developed erythema and began to drain clear fluid from the fingertip. Additionally, the mother noticed "something white" protruded from the end of the fourth fingertip, which "looked like a bone." This fragment was brought with the child to the hospital. An x-ray of the right hand showed a missing distal fourth phalanx.

The patient was admitted to the hospital. Following admission, the patient and her mother denied that she had experienced fever, chills, nausea, bleeding or pain of the affected areas. Her mother stated that her daughter was a "slow healer." In fact, she had a wound on the bottom of her left great toe for 1 year, after stepping on an oyster shell. In spite of having a skin graft to this wound, it still had not healed completely.


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