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Felon

Sections Felon
Overview
Presentation
- History
- Physical
- Causes
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Overview

Background

Felons are closed-space infections of the fingertip pulp.^{[1, 2]}

Pathophysiology

Fingertip pulp is divided into numerous small compartments by vertical septa that stabilize the pad. Infection occurring within these compartments can lead to abscess formation, edema, and rapid development of increased pressure in a closed space. This increased pressure may compromise blood flow and lead to necrosis of the skin and pulp.

Frequency

United States

Felons and paronychias account for approximately one third of all hand infections. Thumb and index finger are the most commonly affected digits.

Mortality/Morbidity

With skin necrosis, spontaneous decompression may occur. When skin does not yield, osteomyelitis, tenosynovitis, and septic arthritis may result.

Clinical Presentation

Franko OI, Abrams RA. Hand infections. Orthop Clin North Am. 2013 Oct. 44(4):625-34. [Medline].
Zyluk A, Puchalski P. [Severe infections within the upper extremity--analysis of the causes and methods of treatment]. Chir Narzadow Ruchu Ortop Pol. 2006. 71(4):239-44. [Medline].
Connolly B, Johnstone F, Gerlinger T, Puttler E. Methicillin-resistant Staphylococcus aureus in a finger felon. J Hand Surg [Am]. 2000 Jan. 25(1):173-5. [Medline].
Barkin JA, Miki RA, Mahmood Z, Landy DC, Owens P. Prevalence of methicillin resistant Staphylococcus aureus in upper extremity soft tissue infections at Jackson Memorial Hospital, Miami-Dade County, Florida. Iowa Orthop J. 2009. 29:67-73. [Medline]. [Full Text].
Pallin DJ, Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA Jr. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2008 Mar. 51(3):291-8. [Medline].
Newfield RS, Vargas I, Huma Z. Eikenella corrodens infections. Case report in two adolescent females with IDDM. Diabetes Care. 1996 Sep. 19(9):1011-3. [Medline].
Glickel SZ. Hand infections in patients with acquired immunodeficiency syndrome. J Hand Surg [Am]. 1988 Sep. 13(5):770-5. [Medline].
Bolton H, Fowler PJ, Jepson RP. Natural history and treatment of pulp space infection and osteomyelitis of the terminal phalanx. J Bone Joint Surg. 1949. 4:499-504.
Canales FL, Newmeyer WL, Kilgore ES. The treatment of felons and paronychias. Hand Clin. 1989 Nov. 5(4):515-23. [Medline].
Clark DC. Common acute hand infections. Am Fam Physician. 2003 Dec 1. 68(11):2167-76. [Medline].
Elston DM. Optimal antibacterial treatment of uncomplicated skin and skin structure infections: applying a novel treatment algorithm. J Drugs Dermatol. 2005 Nov-Dec. 4(6 Suppl):s15-9. [Medline].
Hijjawi JB, Dennison DG. Acute felon as a complication of systemic paclitaxel therapy: case report and review of the literature. Hand (N Y). 2007 Sep. 2(3):101-3. [Medline]. [Full Text].
Kilgore ES Jr, Brown LG, Newmeyer WL. Treatment of felons. Am J Surg. 1975 Aug. 130(2):194-8. [Medline].
Perry AW, Gottlieb LJ, Zachary LS, Krizek TJ. Fingerstick felons. Ann Plast Surg. 1988 Mar. 20(3):249-51. [Medline].
Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. 1999 Oct. 17(6):581-2. [Medline].
Watson PA, Jebson PJ. The natural history of the neglected felon. Iowa Orthop J. 1996. 16:164-6. [Medline].
Zyluk A, Puchalski P. [Severe infections within the upper extremity--analysis of the causes and methods of treatment]. Chir Narzadow Ruchu Ortop Pol. 2006. 71(4):239-44. [Medline].
Anthony Barabas, Andrew Fleming. Hand Infections. I.A. Trail, A.N.M. Fleming. Disorders of the Hand. London: Springer-Verlag; 2015. 1: 415-417.

Media Gallery

Differential diagnosis for a felon includes herpetic whitlow.
A paronychia can progress to a felon if left untreated.
Drainage of pus from under perionychium in a paronychia.

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Author

Jarod Fox, MD Fellow in Infectious Diseases, Orlando Health

Jarod Fox, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, International Society for Infectious Diseases

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Catherine Bowman, MD, PhD Program Director, Infectious Diseases Fellowship Program, Orlando Health; Clinical Assistant Professor, University of Central Florida College of Medicine and Florida State University College of Medicine

Mary Catherine Bowman, MD, PhD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jon Mark Hirshon, MD, PhD, MPH, FACEP Professor, Department of Emergency Medicine, Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine; Chief, Emergency Department, Baltimore VA Medical Center

Jon Mark Hirshon, MD, PhD, MPH, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Novartis<br/>Received income in an amount equal to or greater than $250 from: Novartis.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Acknowledgements

Glen Vaughn, MD Director, Department of Emergency Medicine, Defiance Hospital

Disclosure: Nothing to disclose.

Sections Felon
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Felon

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