Hand and finger infections

Background

• Pts w/ systemic symptoms due to a hand infection are seriously ill; require inpatient management

Deep Space Infection

Background

• Volar surface contains potential deep spaces that may become infected
• Dorsal aspect contains the veins and lymphatics; will always swell whenever there is an inflammatory process

Clinical Features

• Tenderness, induration, or fluctuance over volar aspect of hand
• Pain w/ range of motion of digits

Management

• Parenteral antibiotics
• Hand surgeon consult

Closed Fist Infection "Fight Bite"

Background

• Result of striking another individual's teeth with clenched fist
• Although may appear benign, significant morbidity can result from late presentation or inadequate initial management

Clinical Features

• • Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)

Diagnosis

• Imaging indicated to rule-out fracture, tooth fragments

Treatment

• Prophylactic abx should be initiated for all but the most superficial wounds
  • If no visible signs of infection:
    • Amoxicillin-clavulanate 875/125mg PO BID x5d
  • For signs of infection:
    • Ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm q6h
    • Penicillin allergy: clindamycin plus ciprofloxacin

Paronychia

Background

• Infection of lateral nail fold or perionychium
• Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)

Management

• If no fluctuance is identified:
  • Warm soaks, elevation
  • TMP/SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
• If unclear if wound is fluctuant:
  • Have pt apply pressure to distal aspect of affected digit
  • A larger than expected area of blanching, reflecting a collection of pus, may identify the need for drainage
• If fluctuance or pus is identified:

.18 After suppuration has occurred, the infection will exhibit either fluctuance or identifiable pus that will necessitate drainage. Minor infections can be treated with elevation of the perionychium or eponychium with a flat probe #11 blade (Figure 280-5) or needle slid along the surface of the nail.19 If only elevating the eponychium from the nail, this procedure can be performed without placing a digital block or providing analgesia.20 In general, only nonviable tissue can be incised without provoking pain.

Source

• Tintinalli