Felon: Difference between revisions
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*Infection typically begins w/ minor trauma to dermis overlying finger pad | *Infection typically begins w/ minor trauma to dermis overlying finger pad | ||
**May spread to flexor tendon sheath, IP joint, or underlying periosteum | **May spread to flexor tendon sheath, IP joint, or underlying periosteum | ||
*The inciting event is often a foreign body such as a splinter | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 19:58, 16 November 2014
Background
- Subcutaneous pyogenic infection of the pulp space compartments of the distal finger
- Do not mistake for pulp erythema due to Paronychia or Herpetic Whitlow
- Infection typically begins w/ minor trauma to dermis overlying finger pad
- May spread to flexor tendon sheath, IP joint, or underlying periosteum
- The inciting event is often a foreign body such as a splinter
Clinical Features
- Red, tense, and markedly painful distal pulp space
Diagnosis
- Gram stain and culture (chronic infections may be caused by atypical organisms)
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Treatment
Incision and drainage
(see image below)
- Number 11 blade is used to make incision on nonoppositional side of affected digit
- Start incision 5 mm distal to flexor DIP crease
- End incision 5mm proximal to nail plate border
- Bluntly dissect and explore wound until abscess is decompressed
no need for packing
Disposion
- Instruct pt to keep extremity elevated
- Antibiotics indicated for felons associated with cellulitis
- Dispo with followup in 2 days for wound check
- Ortho only if complications
See Also
Source
- Clark, DC. Common Acute Hand Infections. Am Fam Physician 2003;68:2167-76