We report the case of an adult man who developed distal phalangeal AVN of the right long finger 30 years after trauma. A 64-year-old right-handed man visited the clinic because of right long fingertip pain, which had begun 6 months ago, spontaneously. He was treated with incision and drainage, antibiotics medication at another clinic, for the diagnosis of felon, but his symptoms did not improve. The patient had no evidence of systemic disease. Magnetic resonance imaging (MRI) revealed homogenous low-signal intensity in the marrow of the distal half of distal phalanx on the T1-weighted images. Operation showed that the distal phalangeal bone necrosis is accompanied with mild soft tissue inflammation. We removed the necrotic bone. Histopathological examination revealed that the lesion was an avascular necrosis of the bone with nonspecific soft tissue inflammation. 3 weeks after surgery the patient was no longer symptomatic. At 12-month follow-up, the patient was interviewed over the phone, being completely asymptomatic and doing well. We stress that physician should be in mind that there exists the chance of AVN of phalangeal bone when they encounter the patients complaining about the unknown origin finger pain after the treatment of fingertip infection.

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