eMedicine Specialties > Emergency Medicine > Infectious Diseases

Felon

Author: Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Contributor Information and Disclosures

Updated: Oct 1, 2009

Introduction

Background

Felons are closed-space infections of the fingertip pulp.

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.

A paronychia can progress to a felon if left untr...

A paronychia can progress to a felon if left untreated.

[ CLOSE WINDOW ]
A paronychia can progress to a felon if left untr...

A paronychia can progress to a felon if left untreated.


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

History

  • Wooden splinters or minor cuts are common predisposing causes, yet no history of injury exists in over one half of patients. Infection also may spread from a paronychia.
  • Initial minor injury causes cellulitis, which is first confined by tough fibrous septa that break up pulp into tiny compartments.
    • This early infection causes tight or prickling pain.
    • At this stage, infection may resolve spontaneously, particularly with antibiotics. The number of abortive cases is unknown because many patients never present to the hospital.
  • If resolution does not occur, abscess formation is accompanied by throbbing pain.

Physical

  • Felons are characterized by marked throbbing pain, tension, and edema of the fingertip pulp.

Causes

  • Staphylococcus aureus is the most common cause. Methicillin-resistant Staphylococcus aureus –infected felons have been reported.1,2,3
  • Gram-negative organisms have been reported in immunosuppressed patients. Fingertip blood glucose measurements have been implicated as an etiology,
  • Eikenella corrodens has been reported in persons with diabetes who bite their fingernails.1,4,5

More on Felon

Overview: Felon
Differential Diagnoses & Workup: Felon
Treatment & Medication: Felon
Follow-up: Felon
Multimedia: Felon
References
[ CLOSE WINDOW ]

References

  1. Connolly B, Johnstone F, Gerlinger T, Puttler E. Methicillin-resistant Staphylococcus aureus in a finger felon. J Hand Surg [Am]. Jan 2000;25(1):173-5. [Medline].

  2. 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].

  3. 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. Mar 2008;51(3):291-8. [Medline].

  4. Newfield RS, Vargas I, Huma Z. Eikenella corrodens infections. Case report in two adolescent females with IDDM. Diabetes Care. Sep 1996;19(9):1011-3. [Medline].

  5. Glickel SZ. Hand infections in patients with acquired immunodeficiency syndrome. J Hand Surg [Am]. Sep 1988;13(5):770-5. [Medline].

  6. 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.

  7. Canales FL, Newmeyer WL, Kilgore ES. The treatment of felons and paronychias. Hand Clin. Nov 1989;5(4):515-23. [Medline].

  8. Clark DC. Common acute hand infections. Am Fam Physician. Dec 1 2003;68(11):2167-76. [Medline].

  9. Elston DM. Optimal antibacterial treatment of uncomplicated skin and skin structure infections: applying a novel treatment algorithm. J Drugs Dermatol. Nov-Dec 2005;4(6 Suppl):s15-9. [Medline].

  10. Hijjawi JB, Dennison DG. Acute felon as a complication of systemic paclitaxel therapy: case report and review of the literature. Hand (N Y). Sep 2007;2(3):101-3. [Medline].

  11. Kilgore ES Jr, Brown LG, Newmeyer WL. Treatment of felons. Am J Surg. Aug 1975;130(2):194-8. [Medline].

  12. Perry AW, Gottlieb LJ, Zachary LS, Krizek TJ. Fingerstick felons. Ann Plast Surg. Mar 1988;20(3):249-51. [Medline].

  13. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. Oct 1999;17(6):581-2. [Medline].

  14. Watson PA, Jebson PJ. The natural history of the neglected felon. Iowa Orthop J. 1996;16:164-6. [Medline].

  15. 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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

felon, paronychia, fingertip infection, finger infection, closed-space infections, fingertip pulp, paronychias, hand infections, osteomyelitis, tenosynovitis, septic arthritis, Staphylococcus aureus, S aureus, Eikenella corrodens, E corrodens, wood splinter, minor cut, cellulitis, skin necrosis 

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH 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, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.