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In the syphilitic lesion, skiagrams usually show a more abundant formation of new bone, but in many cases the doubt is only cleared up by observing the results of the tuberculin test or the effects of anti-syphilitic treatment. Sarcoma of a phalanx or metacarpal bone may closely resemble a dactylitis both clinically and in skiagrams, but it is rare. Treatment.
The lesion presents, on a small scale, all the anatomical changes that have been described as occurring in the medulla of the tibia or ulna, and they are easily followed in skiagrams. A periosteal type of dactylitis is also met with. The clinical features are those of a spindle-shaped swelling of a finger or toe, indolent, painless, and interfering but little with the function of the digit.
When several bones and joints are simultaneously affected, and there are sinuses with mixed infection, amputation is usually indicated, especially in adults. #Tuberculous dactylitis# is the name applied to a diffuse form of the disease as it affects the phalanges, metacarpal or metatarsal bones.
The contrast between the grossly enlarged and misshapen tibia and the normal or even attenuated fibula is a striking one. Treatment is carried out on lines similar to those recommended in the acquired disease. When curving of the tibia causes disability in walking, the bone may be straightened by a cuneiform resection. Syphilitic dactylitis is met with chiefly in children.
Gummatous disease is frequently observed also in the flat bones of the skull, in the bones of the hand, as syphilitic dactylitis, and in the bones of the forearm and leg. When the tibia is affected the disease is frequently bilateral, and may assume the form of gummatous ulcers and sinuses.
The lesion consists in a gummatous infiltration of the soft parts surrounding the phalanx, or a gummatous osteomyelitis, but there is practically no tendency to break down and discharge, or to the formation of a sequestrum as is so common in tuberculous dactylitis.
When growing in the interior of a bone it causes a spindle-shaped enlargement of the shaft, which in the case of a phalanx or metacarpal bone may resemble the dactylitis resulting from tubercle or syphilis. A chondroma appears as a clear area in a skiagram.
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