*Yale New Haven Hospital, New Haven, CT.
†Connecticut Podiatry Group, New Haven, CT.
J Am Podiatr Med Assoc. 2024 Mar-Apr;114(2). doi: 10.7547/23-091.
Bone and periarticular tissue discoloration can be an unexpected finding that is often disconcerting for surgeons and may alter surgical plans and overall patient management. Common causes of bone discoloration include infection, avascular necrosis, and bone inflammation. Minocycline-induced black bone disease is a rare and relatively benign abnormality encountered in foot and ankle surgery that can cause significant black, blue, and gray discoloration of bone.
Unanticipated intraoperative findings of diffuse black, blue, and gray bone discoloration during an elective forefoot operation raised concern for a metabolically malignant process and prompted the conversion of plans for a first metatarsophalangeal joint implant arthroplasty to a Keller arthroplasty. The plan for proximal interphalangeal joint arthroplasties of the lesser digits were continued as planned. Bone specimens were sent for pathologic analysis.
Postoperative analysis identified chronic use of a minocycline for acne vulgaris. Pathologic analysis of the specimens ruled out malignant processes. Altogether, the data available led to the diagnosis of minocycline-induced black bone disease. Since the last follow-up, the patient has healed well without complications.
Our case report underscores the importance of including the chronic use of tetracyclines in medical history intake during preoperative visits to assist the surgeon in intraoperative decision-making.
骨和关节周围组织变色可能是出乎意料的发现，常使外科医生感到困惑，并可能改变手术计划和整体患者管理。骨变色的常见原因包括感染、 缺血性坏死和骨炎症。米诺环素诱导的黑骨病是足部和踝关节手术中罕见且相对良性的异常，可导致骨的显著黑色、蓝色和灰色变色。
在择期前足手术中，术中发现弥漫性黑色、蓝色和灰色骨变色，令人担忧代谢恶性过程，并促使将第一跖趾关节植入关节成形术的计划改为 Keller 关节成形术。较小的近节指间关节关节成形术的计划按计划继续进行。送检骨标本进行病理分析。
术后分析确定了慢性使用米诺环素治疗寻常痤疮。标本的病理分析排除了恶性过程。总的来说，现有数据导致了米诺环素诱导的黑骨病的诊断。自最后一次随访以来，患者恢复良好，无并发症。
我们的病例报告强调了在术前访视中询问病史时，包括慢性使用四环素的重要性，以协助外科医生进行术中决策。
