FELON

Question 1

an abscess of the distal phalanx fat pad. S. aureus is the most common
pathogen. The patient usually presents with a painful and swollen distal pulp space.
Nearly always follows minor finger injury (i.e. splinter or needle prick).

Answer 1

felon

Question 2

Felon Presentation

Answer 2

(1) Condition is characterized by severe pain, exquisite tenderness, and tense swelling of
the distal digit with erythema. There may be a visible collection of pus or palpable
fluctuance.
(2) Septa between the pulp spaces limits the spread of infection, resulting in an abscess,
creating pressure and necrosis of adjacent tissues.
(3) Underlying bone, joint or flexor tendons may become infected

Question 3

Felon Treatment

Answer 3

(1) Prompt incision, with division of the fibrous septa to ensure adequate drainage.
(2) Should be performed by Dermatologist if available.
(3) IDC should treat with antibiotics.
(a) MSSA- Systemic antibiotics - Dicloxacillin or Keflex are indicated.
(b) If MRSA suspected, trimethoprim/sulfamethoxazole, clindamycin, or
doxycycline, should be used.
(c) Rest and immobilization
(d) Elevation
(e) Wet Normal saline dressings 3-4 times daily when ulcerating
(f) Pain management: NSAIDS, Narcs may be required

Question 4

(1) Differential diagnosis:

Answer 4

Cellulitis

Question 5

Labs/Studies/Imaging:

Answer 5

(a) Imaging/x-ray to evaluate for retained foreign body and to rule out involvement
of the distal phalanx

Question 6

Disposition

Answer 6

(a) Light Duty, no use of affected hand until signs of infection have resolved and
wound has healed.

Question 7

Complications

Answer 7

(a) Osteitis & osteomyelitis
(b) Ulceration and tissue necrosis
(c) Flexor tenosynovitis
(d) Septic arthritis