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Barger J, Hoyer RW. Fingertip Infections. Orthop Clin North Am 2024; 55:265-272. [PMID: 38403372 DOI: 10.1016/j.ocl.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The fingertip is the interface between humans and the world, including the various thorns, dirty needles, and other hazards to be found there. It is unsurprising that this is the site where hand infections most frequently occur. Although commonly encountered by hand surgeons and other physicians, fingertip infections have several mimics, and diagnosis and management is not always straightforward. Early diagnosis and treatment are key to success. As with all infections, they are more common and are more aggressive in immunosuppressed patients. This article reviews fingertip anatomy, common and uncommon fingertip infections and their mimics, and recommendations for management.
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Affiliation(s)
- James Barger
- Indiana Hand to Shoulder Center, Indianapolis, IN, USA
| | - Reed W Hoyer
- Indiana Hand to Shoulder Center, Indianapolis, IN, USA.
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2
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Osmani S, Schairer DO. Acute paronychia in a neonate secondary to clindamycin-resistant Staphylococcus aureus. Pediatr Dermatol 2022; 39:985-986. [PMID: 36047838 DOI: 10.1111/pde.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/13/2022] [Accepted: 04/10/2022] [Indexed: 11/27/2022]
Abstract
Paronychia is a common inflammatory condition of the nail fold that is often associated with infection. Causes can be fungal, viral, or most commonly, bacterial. Neonatal paronychia is a rare presentation with only one previously reported case in the literature of a patient younger than 1 month of age. This is a case of an 8-day-old neonate with acute bacterial paronychia caused by clindamycin-resistant Staphylococcus aureus.
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Affiliation(s)
- Sabah Osmani
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - David O Schairer
- Department of Dermatology, University of California San Diego School of Medicine, La Jollax, California, USA.,Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California, USA
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Lemme NJ, Li NY, Testa EJ, Kuczmarski AS, Modest J, Katarincic JA, Gil JA. A Nationwide Epidemiological Analysis of Finger Infections Presenting to Emergency Departments in the United States From 2012 to 2016. Hand (N Y) 2022; 17:302-307. [PMID: 32354232 PMCID: PMC8984722 DOI: 10.1177/1558944720915614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: There is a paucity of literature exploring the epidemiology of finger infections presenting to emergency departments (EDs) on a national scale. The purpose of this study was to determine the national incidence of and risk factors for finger infections. Methods: Finger infections presenting to EDs between 2012 and 2016 were identified in the National Electronic Injury Surveillance System database. Finger infections were characterized by mechanism and type, with subanalyses for sex, race, and age. Results: Over this 5-year period, finger infections accounted for 80 519 visits to EDs in the United States. The annual incidence increased significantly from 4.4 per 100 000 person-years in 2012 to 6.2 in 2016. The 3 most common causes of finger infections were nail manicuring tools, knives, and doors. The most common diagnosis was finger cellulitis (46.3%). Significantly more men developed finger infections than women (relative risk of 1.4). The highest overall incidence was observed in 40- to 59-year-old men (7.8 per 100 000 person-years). Tenosynovitis resulted in the largest proportion of admissions (25%). Conclusions: We have demonstrated a rising incidence of finger infections presenting to EDs, with 40- to 59-year-old patients most at risk. The most common mechanism was the use of nail manicuring tools, such as nail clippers. Patient education may decrease finger infection incidence from these activities, and early detection of finger infections may be crucial to minimizing hospital admissions and invasive treatments.
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Affiliation(s)
- Nicholas J. Lemme
- Alpert Medical School of Brown
University, Providence, RI, USA,Nicholas J. Lemme, Department of Orthopaedic
Surgery, Alpert Medical School of Brown University, 593 Eddy Street, Providence,
RI 02903, USA.
| | - Neill Y. Li
- Alpert Medical School of Brown
University, Providence, RI, USA
| | - Edward J. Testa
- Alpert Medical School of Brown
University, Providence, RI, USA
| | | | - Jacob Modest
- Alpert Medical School of Brown
University, Providence, RI, USA
| | | | - Joseph A. Gil
- Alpert Medical School of Brown
University, Providence, RI, USA
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Homogenization of the management of acute paronychia with abscess formation within the context of an evaluation of professional practices. Orthop Traumatol Surg Res 2021; 107:102982. [PMID: 34102333 DOI: 10.1016/j.otsr.2021.102982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/18/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The performance of an evaluation of professional practices (EPP) using a clinical audit measures the quality of our practices with the aim of standardizing them. Therefore, the primary objective of this study was to develop a clinical pathway for the management of acute paronychia with abscess formation. The secondary objectives were to evaluate our professional practices using a clinical audit before and after the dissemination of the clinical pathway and then recommend strategies for improving our management of acute paronychia with abscess formation. MATERIALS AND METHODS A working group was established that designed an audit grid comprised of 15 items. Thirty patients (Group 1) who had an acute paronychia with abscess formation were included and their health records were analyzed using this audit grid. The working group then developed a clinical pathway for the management of acute paronychia with abscess formation. Thirty new patients (Group 2) were included after the dissemination of this clinical pathway and their records were analyzed using the same audit grid. RESULTS Our clinical pathway for the management of acute paronychia was validated by the local infectious disease committee of our university hospital center. The difference between groups 1 and 2 was significant (p<0.05) for eight items. There was no significant difference in the rate of surgical revision between the two groups. DISCUSSION This EPP enabled us to develop a clinical pathway that detailed the processes for managing acute paronychia with abscess formation, and in particular it provided indications for antibiotic therapy and its limitations. LEVEL OF EVIDENCE IV, retrospective study.
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Olvera-Rodríguez V, Gatica-Torres M, Carrillo-Córdova DM, Barrera-Godínez A, Domínguez-Cherit J. Painful nails: A practical approach to the diagnosis and management of painful nail conditions. Int J Dermatol 2021; 60:1318-1333. [PMID: 33720408 DOI: 10.1111/ijd.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
Because several nail disorders share similar clinical features, their diagnosis and management can be challenging to clinicians. The physical examination may disclose localized abnormalities or point to an underlying systemic disease, requiring additional workup. Furthermore, cosmetic distress and nail-related symptoms (e.g., tingling, stinging, numbness, and pain) are common factors that influence the patient's search for medical assistance. Nail pain (i.e., onychalgia) can accompany both localized and systemic pathology. Onychalgia can be acute or chronic according to the time of evolution; patients may describe it as intermittent or constant, and as a throbbing, burning, sharp, or shooting sensation denoting the nature of the pain. It may be exacerbated by colder temperatures, touch, and increased activity (e.g., manipulating objects, walking). We present four main groups of conditions that might cause nail pain: nail tumors, nail deformities, inflammatory or infectious diseases, and external or traumatic agents. Our article includes an overview of the clinical features, as well as diagnosis and management pearls for each entity. Physicians (dermatologists and nondermatologists) should be aware that abnormalities of the ungual and subungual space are not exclusive of dermatological disorders but may also be present in noncutaneous contexts.
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Affiliation(s)
- Valeria Olvera-Rodríguez
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Michelle Gatica-Torres
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico.,Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Dulce María Carrillo-Córdova
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alejandro Barrera-Godínez
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Abstract
Bacterial and viral infections of the nail unit are very common as primary infections, especially bacterial paronychia and warts, but they can also be superinfections complicating other nail disorders. In many nail unit infections, the clinical presentation is nonspecific: in these cases, diagnostic tests are mandatory before treatment, to avoid spread of the infection and drug resistance. The most common forms of bacterial and viral infections that may affect the nail unit are herein described in detail, with diagnostic and treatment options provided.
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Affiliation(s)
- Matilde Iorizzo
- Private Dermatology Practice, Viale Stazione 16, Bellinzona 6500, Switzerland.
| | - Marcel C Pasch
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, Nijmegen 6525GL, The Netherlands
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Abstract
The fingertip is the most common site of infections in the hand, which frequently are encountered by surgeons, dermatologists, and emergency and primary providers. Their mismanagement may have serious consequences. This review discusses the unique anatomy of the volar fingertip pulp and perionychium and reviews pathophysiology and treatment of acute and chronic paronychia, including the decision for surgical versus medical management, choice of antibiotics, incisional techniques, and postincisional care. Felons and the evidence regarding their management are reviewed. Several infectious, rheumatologic, and oncologic conditions that may mimic common fingertip infections and about which the managing provider must be aware are presented.
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Affiliation(s)
- James Barger
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, MGH Orthopaedic Hand Surgery, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114-2696, USA
| | - Rohit Garg
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, MGH Orthopaedic Hand Surgery, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114-2696, USA
| | - Frederick Wang
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, MGH Orthopaedic Hand Surgery, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114-2696, USA
| | - Neal Chen
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, MGH Orthopaedic Hand Surgery, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114-2696, USA.
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Abstract
Hand infections can lead to debilitating and permanent disability, particularly if they are not treated promptly or properly. The unique anatomy of the hand, with its numerous enclosed and confined spaces, warrants special considerations. For instance, infections in deep spaces of the hand may require surgical drainage despite an appropriate course of antimicrobial treatment. Thorough history and examination are crucial in guiding further investigations and management, particularly because there are numerous mimickers of hand infections, such as gout and pseudogout.
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Affiliation(s)
- Wendy Z W Teo
- Department of Hand and Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Level 11, Singapore 119228, Singapore.
| | - Kevin C Chung
- The University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, USA
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Rabarin F, Jeudy J, Cesari B, Petit A, Bigorre N, Saint-Cast Y, Fouque PA, Raimbeau G. Acute finger-tip infection: Management and treatment. A 103-case series. Orthop Traumatol Surg Res 2017; 103:933-936. [PMID: 28554808 DOI: 10.1016/j.otsr.2017.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/22/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute fingertip infections (AFTI) are common. Surgical treatment is the norm in case of effusion. There is, however, no consensus on treatment modalities, or on adjuvant antibiotic therapy (AT). We present the results of a consecutive cohort of 103 AFTIs treated in emergency consultation. MATERIALS AND METHOD One hundred and one patients were treated by excision and extensive lavage under digital anesthesia, with systematic bacteriological sampling. Patient history, treatment history, location, type of bacteria, complications or recurrences and AT prescription were recorded and analyzed. All patients were reviewed at first dressing (5-7 days) and recontacted at 1 month, to record any pain, stiffness or recurrence. Three groups were distinguished: A: without preoperative AT (n=71); B: under AT before surgery (n=14); C: with postoperative AT (for severe comorbidity) (n=16). RESULTS Mean age was 39.7 years (range: 14-84 years). The three main types of bacteria were: Staphylococcus aureus (58.3%), polymicrobial flora (16.5%), and Streptococcus (12.6%). Mean time to first dressing was 5.7 days. There were no recurrences, whatever the bacterial type or patient group. In 5 patients in group A (8.2%), AT was later prescribed at day 5 (3 for hypercicatrization and 2 for maceration). In groups B and C, progression was unproblematic. At 1 month, all patients considered themselves cured; finger-tip sensitivity was conserved in 10, and 16 were awaiting complete nail regrowth. DISCUSSION Hospital admission, operative treatment under general anesthesia, and AT are factors exacerbating cost and increase the management burden of AFTI. Treatment in emergency consultation seems perfectly feasible. AT does not seem useful in the absence of severe comorbidities if resection is complete. Analysis of bacterial susceptibility and renewal of the initial dressing at 1 week enable progression to be monitored and treatment changed as necessary.
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Affiliation(s)
- F Rabarin
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France.
| | - J Jeudy
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - B Cesari
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - A Petit
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - N Bigorre
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - Y Saint-Cast
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - P-A Fouque
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
| | - G Raimbeau
- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
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- Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France
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Abstract
BACKGROUND Paronychia is defined as infection afflicting the eponychial nail folds of the hand or foot. Such infections are rarely reported in the perinatal age group, and not previously described in a neonate younger than 2 weeks. Trauma resulting in inoculation of the nail fold is the most common predisposing factor to paronychia. Oral trauma in the pediatric population from finger sucking predisposes this population to a different set of bacterial pathogens than adults. Contamination can progress to infection and abscess formation within the nail fold with the most prevalent vector in adult infections being Staphylococcus aureus. Comparatively, mixed anaerobic and aerobic infections tend to afflict children with oral soothing habits. METHODS This is a case report will present the rare occurrence of a paronychia in a neonate caused by methicillin-resistant Staphylococcus aureus. RESULTS The management and treatment strategies for paronychia in this atypical neonatal patient consisted of incision and drainage and antibiotic therapy. CONCLUSION Neonates with oral self-soothing behaviors may be more at risk for developing paronychia of mixed anaerobic and aerobic infections. Initial therapy with broad-spectrum antibiotics amoxicillin/clavulanate or clindamycin is suggested. Incision and drainage in the perinatal setting coupled with antibiotics is curative.
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Affiliation(s)
- Luke Grome
- West Virginia University School of Medicine, Morgantown, USA
| | - Gregory Borah
- West Virginia University School of Medicine, Morgantown, USA,Gregory Borah, Professor and Chief, Division of Plastic, Reconstructive and Hand Surgery, School of Medicine, West Virginia University, PO Box 9238, Morgantown, WV 26505, USA.
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Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients. HAND SURGERY & REHABILITATION 2016; 35:40-3. [DOI: 10.1016/j.hansur.2015.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 11/21/2022]
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Patel DB, Emmanuel NB, Stevanovic MV, Matcuk GR, Gottsegen CJ, Forrester DM, White EA. Hand Infections: Anatomy, Types and Spread of Infection, Imaging Findings, and Treatment Options. Radiographics 2014; 34:1968-86. [DOI: 10.1148/rg.347130101] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Osterman M, Draeger R, Stern P. Acute hand infections. J Hand Surg Am 2014; 39:1628-35; quiz 1635. [PMID: 25070032 DOI: 10.1016/j.jhsa.2014.03.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 02/02/2023]
Abstract
The continued emergence of antibiotic-resistant bacteria and the development of only a few new classes of antibiotics over the past 50 years have made the treatment of acute hand infections problematic. Prompt diagnosis and treatment are important, because hand stiffness, contractures, and even amputation can result from missed diagnoses or delayed treatment. The most common site of hand infections is subcutaneous tissue and the most common mechanism is trauma. An immunocompromised state, intravenous drug abuse, diabetes mellitus, and steroid use all predispose to infections.
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Affiliation(s)
- Meredith Osterman
- Mary S. Stern Hand Fellow, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Reid Draeger
- Mary S. Stern Hand Fellow, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Peter Stern
- Mary S. Stern Hand Fellow, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Abstract
Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. Paronychia typically develops following a breakdown in the barrier between the nail plate and the adjacent nail fold and is often caused by bacterial or fungal pathogens; however, noninfectious etiologies, such as chemical irritants, excessive moisture, systemic conditions, and medications, can cause nail changes. Abscesses associated with acute infections may spontaneously decompress or may require drainage and local wound care along with a short course of appropriate antibiotics. Chronic infections have a multifactorial etiology and can lead to nail changes, including thickening, ridging, and discoloration. Large, prospective studies are needed to identify the best treatment regimen for acute and chronic paronychia.
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Abstract
Many acute hand and upper extremity infections should be treated as surgical emergencies to avoid stiffness, contracture, pain, and amputation. Proper treatment requires understanding of anatomy and how this influences the behavior of certain infections, common offending organisms, antibiotic treatment, management of host factors, and surgical intervention. This article reviews the microbiology, antibiotic coverage, and surgical treatment of the most common infections in the hand: paronychia, felon, herpetic whitlow, flexor tenosynovitis, deep space infections, septic arthritis, bites from humans and animals, necrotizing fasciitis, mycobacterium infections, and fungal infections. Recommendations are based on the most recent available evidence.
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Affiliation(s)
- Orrin I Franko
- University of California, San Diego School of Medicine, San Diego, CA, USA
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