Chronic Ulceration on Hand

The appearance of a wound on the hand of a 102-year-old man concerned his nursing home's staff. Several months earlier, the patient had had a squamous cell carcinoma removed from the wound site and had undergone subsequent radiotherapy. A nonhealing skin ulcer developed at the site; a skin graft was performed.

The staff suspected that an exposed tendon was protruding from the wound. Initial roentgenographs and a bone scan detected no osseous involvement. However, during direct examination, Dr Jack E. Cohen of Ozark, Ala, subsequently found the lesion to be a fractured bone spike.

The wound healed slowly after an ostectomy, debridement, and local wound care. There was no evidence of gross infection.