What, other than a bacterial infection, would cause an inch of bone to crumble? a bone infection was evident in an x-ray and mri following the straightening of a hammer-toe. upon removal of the surgical screw, approx. an inch of bone crumbled. the biopsy

In : In the absence of infection, one of the causes of bone to "crumble" (i'm not sure what you mean by that term, but i'm assuming there is some kind of bone loss) is aseptic necrosis, where bone, well, rots, if the blood supply to that section of the bone is compromised. Assuming this is the case here, such a compromise could have been the result of the surgery, tissue manipulation, or the screw used to fixate the area. It's a rare complication of hammertoe surgery. But i'm not convinced you really don't have an infection, as infection is a far more common complication following any surgery. When the bone culture was performed, did they test for aerobic, anaerobic, acid fast and fungal organisms? How was the piece of bone obtained for culture? It's entirely possible the piece of bone that was obtained for culture was not a piece that was infected. Also, if you were already taking antibiotics at the time of the culture, that, too, would explain the lack of any bacterial growth. One of the hallmark signs of a bone infection is chronic swelling, although given you are post-op, this might not be a reliable sign. A more specific test for infected bone like a white blood cell labeled nuclear scan is probably a reasonable way to go at this point. A regular bone scan now would not be diagnostic, since any surgery within the past year would cause a regular bone scan to light up. It might be a good idea to take an oral antibiotic for a couple of months, given the "clinical" diagnosis of a bone infection. Modern oral antibiotics have been showed to achieve the same or even higher levels inside bone compared to IV antibiotics, which had always been the "gold standard" in treating bone infections. Hope this helps. Good luck.

In : In addition to what dr. Fox noted, i would add that gout can present this way. I saw a lady with a swollen, painful toe and one of the bones was essentially destroyed. I was worried about a tumor. I opened the toe for a biopsy and got white, pasty crystals. Gout had completely eroded the phalanx. You will have to ask your surgeon how much of the toe was opened to correct the hammertoe and if he/she saw any crystal material.

Many possibilities: Other than an infection, gout, avascular necrosis, charcot arthopathy, and tumors could result in the "crumbling of bones".

Infection: All good answers - especially dr fox's treatise . I , like dr kass would like to know more as well. No one mentioned a contaminated screw - that , too , is possible as the inciting or delivery agent.