Principles
- Trauma is the most common cause, 90% gram + organisms
- Most common organisms – S aureus, S viridans, GAS, S. epidermidis, bacteroides melaninogenicus
- 5 cardinal signs: rubor (red), calor (hot), tumour (swollen), dolor (painful), functio laesa (loss of function)
Types of infections
- Deep Palmar Space infections – uncommon, involve thenar / mid-palm
- Tx in OR
- Felon: subcut abscess in the fingertip, often following severe paronychia or a puncture wound into digit pad
- may assoicated with osteomyelitis
- Tx elevation, warm soaks, coxacillin 500mg po q6h, I&D if abscess
- Flexor Tendon Sheath Infection – accute suppurative tenosynovitis
- Staph>strep>gram – rods
- Often caused by penetrating injury & can lead to tendon necrosis + rupture if not Tx
- Kanavel’s 4 cardinal signs:
- Point tenderness along flexor tendon sheath (earlier & most important)
- Severe pain on passive extension (2nd most important)
- Fusiform swelling of entire digit
- Flexed posture (increased comfort)
- Tx: OR I&D, irrigation, IV abx, resting hand splint until infection resolves
- Herpetic Whitlow – painful vesicle(s) around fingertip
- HSV1/2 – often found in dental/medical personnel & children
- Can be associated with fever, malaise, LN – pt is infectious until lesion has completely healed
- Tx: routine Cx & viral prep protection (cover), +/- acyclovir
- Paronychia – infection of soft tissue around fingernail (beneath eponychial fold)
- acute (staph) – caused by a hangnail, artificial nails, and nial biting
- Tx: warm compress & keflex 500mg po q6h + I&D if abscess present
- chronic (candida) – caused by prolonged exposure to moisture
- Tx: anti-fungals with possible debridement & marsupialization, removal of nail plate
- acute (staph) – caused by a hangnail, artificial nails, and nial biting
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