Salvage of a Lesser Toe Osteomyelitis when Complicated by a Broken Screw: A Case Study

Orthopedic screw removal has proven itself to be a challenge. Access to a Screw Removal Set (TM Synthes) is essential. But what options are available when it cannot remove a broken screw in a lesser toe on a background of osteomyelitis of a lesser toe? A young healthy patient had undergone a 2nd and 3rd toe proximal interphalangeal joint (PIPJ) and distal interphalangeal joint (DIPJ) fusion using a cannulated dual threaded compression screw in 2006. She had had a successful fusion but eight years later, she developed osteomyelitis in the 2nd toe. An attempt was made to manage this conservatively with antibiotic therapy but a further flair up occurred following treatment. At surgery, the screw head broke while trying to remove it leaving just the smooth shaft of the screw, deep within the proximal phalanx. The Screw Removal Set was not useful and it was removed by making a gutter dorsally.