Ultrasound diagnosis of a pathological fracture of the phalanx in a patient with chronic kidney disease: After a 2-month diagnostic delay

A 56-year-old man was admitted to our clinic with pain, swelling, and tenderness in the third finger of his right hand for 2 months. He did not report a physical injury. He was admitted to other clinics for these symptoms, where he was misdiagnosed inflammatory arthritis and treated with deflazacort (30 mg/day). He has a history of chronic kidney disease (CKD) and has been undergoing hemodialysis for 4 years. On physical examination, he had pain and edema on the proximal interphalangeal joint of the right hand (Fig. 1), and no warmth or change in color was noted. In addition, there were no findings of active peripheral arthritis. Blood culture was positive for Staphylococcus epidermidis, and he was administered an intravenous antibiotic. An ultrasound examination performed for the finger due to these clinical findings showed a fracture line in the proximal phalanx of the third finger