Felon 

  • Author: Glen Vaughn, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Mar 25, 2010
 

Background

Felons are closed-space infections of the fingertip pulp.

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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 felon is shown in the image below.

A paronychia can progress to a felon if left untreA paronychia can progress to a felon if left untreated.
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Epidemiology

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.

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Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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  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 and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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].

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