felon

Introduction

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

Complications

• osteomyelitis
• tenosynovitis
• septic arthritis

Differential diagnosis

• cellulitis
• paronychia
• herpetic whitlow

Management

• antibiotics with progression of pain
  • activity against Staphylococcus aureus & Streptococcus
• surgical consult
  • minor surgery to decompress to preserve venous flow

More general terms

• nail disease
• bacterial infection