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felon
closed-space infections of the fingertip pulp
Etiology:
- paronychia
- wooden splinters or minor cuts predispose
- idiopathic (50%)
- organisms
- Staphylococcus aureus, MRSA
- gram negative organisms in immunosuppressed patients
- Eikenella corrodens in patients with diabetes who bite their fingernails
Pathology:
- cellulitis
- abscess formation
- edema
- increased pressure in a closed space
- may compromise blood flow
- may lead to necrosis of surrounding tissue
Clinical manifestations:
- thumb & index finger are the most commonly affected digits
- throbbing pain
- edema of the fingertip pulp
Laboratory:
- none indicated
Radiology:
- imaging if osteomyelitis suspected
- plain radiograph
- magnetic resonance imaging
Differential diagnosis:
- cellulitis
- paronychia
- herpetic whitlow
Complications:
- osteomyelitis
- tenosynovitis
- septic arthritis
Management:
- antibiotics with progression of pain
- activity against Staphylococcus aureus & Streptococcus
- surgical consult
- minor surgery to decompress to preserve venous flow
General
nail disease
bacterial infection
References
- Vaughn G
Felon: eMedicine
http://emedicine.medscape.com/article/782537-overview