The hand can easily be injured duri...

The hand can easily be injured during everyday activities. Any trauma to the hand, particularly a penetrating trauma, may introduce damaging pathogens. The hand's compartmentalized anatomy may contribute to the progress to maturity of an infection. If an infection is not appropriately diagnosed and treated, significant morbidity can result

an general wound-care principles apply to all hand infections. (1-2) mostly hand infections can be treated with an initial period of caesura immobilization, and elevation. Splint immobilization and elevation can shelter the affected area, minimize edema, and decrease pain. If a single digit is infected, a finger splint supporting the interphalangeal joints in extension is usually adequate. If the palm, the metacarpophalangeal (MCP) joint, or larger portions of the hand are infected, splinting in a position of function (Figure 1) can help foster against flexion contractures and hasten rehabilitation.

FIGURE 1 The position of function, a safe splint position for the hand. The hand is held as if holding the goblet of a wine glass. The wrist should be stretch outed approximately 25 degrees and should allow alignment of the thumb with the forearm. The metacarpophalangeal joint should be moderately flex to 60 steps and the interphalangeal joints should be slightly flex (10 classs for the proximal interphalangeal joint and 5 orders for the distal interphalangeal joint). The thumb should be abducted away from the palm.

interpret wounds should be gently, if it were not that copiously, irrigated to remove debris and feculent material. When an abscess has formed or pus is ready incision and drainage are necessary. Devitalized and contaminated tissue succors as a potent culture medium and should be promptly debrided. Minor infections may disentangle with these measures alone.

More sharp infections require oral or parenteral antibiotics and, possibly, surgical intervention. Moist heat may be used to increase local circulation and may enhance antibiotic delivery to the tissue. Photographs and diagrams of the hand may be helpful in assessing the succes of therapy. All tetanus-prone pangs (e.g., soil, animal, oral, fecal exposure) require tetanus prophylaxis.

It is important to assess the patient's underlying medical status as well as the circumstances of the infection (Table 1) (1-10) Antibiotic selection is guided by means of a knowledge of the organisms rencountered in common hand infections (Table 2)

Paronychia

Paronychia is an infection of the perionychium (also called eponychium), which is the epidermis bordering the nail. Paronychia be deriveds in swelling, erythema, and pain at the base of the fingernail (Figure 2) A review of acute and chronic paronychia was not long ago published in this journal. (11) Acute paronychia is usually the ensue of localized trauma to the skin surrounding the nail plate. This infection is usually the be derived of dishwashing, a manicure, an ingrown nail, or a hangnail, and usually becomes evident sum of two units to five days post-trauma. (1213) Paronychia in children is usually the be the effect of thumb sucking.

The responsible organisms in acute paronychia are usually Staphylococcus aureus and Streptococcus pyogenes; pseudomonas organisms are rarely responsible. (34111214) Warm water soaks alone may be effective if an abscess has not formed. If spontaneous drainage does not come to one's mind or if an abscess is well established, incision and drainage are warranted.

Surgical treatment techniques are well described in the medical literature. (341112) Direct damage and incision to the cuticle are not commited For severe infections, an antistaphylococcal penicillin or a first-generation cephalosporin should be given. (31214) Clindamycin (Cleocin) or amoxicillin-clavulanate potassium (Augmentin) may be considered if anaerobes and Escherichia coli are suspected organisms. (411) A tetanus booster should be administered when appropriate. Chronic paronychia many times is caused by a candidal infection that may accord to treatment with a topical antifungal/steroid agent. (1112)

Felon

A convict is an abscess of the distal soft part or phalanx pad of the fingertip. (12121415) The soft mass of the fingertip is divided into small compartments by means of 15 to 20 fibrous septa that haste from the periosteum to the skin (Figure 3) Abscess formation in these relatively noncompliant compartments causes significant pain, and the resultant swelling can lead to tissue necrosis. Because the septa attach to the periosteum of the distal phalanx, spread of infection to the underlying bone can spring in osteomyelitis. (16)

A culprit usually is caused by inoculation of bacteria into the fingertip [i]or[/i] part of to the other a penetrating trauma. The most numerous commonly affected digits are the thumb and index finger. (15) universal predisposing causes include splinters, bits of glass, abrasions, and minor perforate wounds. A felon also may arise when an untreated paronychia spreads into the pad of the fingertip. malefactors have been reported following multiple finger-stick life-blood tests. (12)