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. The infection may lead to osteomyelitis and other serious life and limb threatning diseases.
Epidemiology
Frequency
United States
Felons may account for up to 15% to 20% of all hand infections; howevever, a large retrospective review found this infection accounting for 5% of all hand infections that underwent incision and drainge. [3] Therefore, it is likely that they account for an even small number of hand infections. The thumb and second digit are the most commonly affected digits. Often, a felon may develop from a localized fingertip infection such as a paronychia.
Mortality/Morbidity
Left untreated, osteomyelitis, tenosynovitis, and septic arthritis may result. In addition, the infection can lead to fingertip destruction through spontaneous decompression toward the skin.
Prognosis
Given the severity of the pain and swelling patients usually present within the first several days and have a favorable prognosis. With early treatment, the prognosis is excellent with possible minor complications such as pain, sensitivity of the fingertip, pulp atrophy and deformity.
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Differential diagnosis for a felon includes herpetic whitlow.
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A paronychia can progress to a felon if left untreated.
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Drainage of pus from under perionychium in a paronychia.
