Laboratory Studies

Perform Gram stain and culture on any fluid removed from the wound.

Imaging Studies

Radiographs should be obtained if there is a history of penetration with a radiopaque foreign body, if the history is unclear or if there is concern for underlying bone involvement.

Radiographic evaluation should be performed in severe cases and in immunocompromised patients if there is concern for osteomyelitis, joint involvement or any other concerning symptoms.

Other Tests

Serum tests are generally not indicated.

If there is concern that the patient needs definitive treatment in the operating room or has osteomyelitis, a complete blood count, basic metabolic profile, erythrocyte sedimentation rate and c-reactive protein may be performed. Blood cultures can also be obtained if providing intravenous antibiotics or if there is concern for sepsis.

Treatment & Management

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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

Brandon Stein, MD Medical Student Clerkship Director, Core Faculty, Department of Emergency Medicine, Kendall Regional Medical Center

Brandon Stein, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

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, MPH, PhD, 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, MPH, PhD, 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: 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

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.

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.

Acknowledgements

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

Disclosure: Nothing to disclose.