Hand infections Flashcards
principles of treatment
- Tetanus Toxoid if indicated (prophylaxis)
- Drain the pus and allow continued drainage ( do not suture)
- Bacteriological diagnosis
- Elevation
- Splint (“safe” position & helps drainage)
- Appropriate Antibiotics
- Early mobilization and rehabilitation (on day 1)
- Adequate analgesia to allow mobilization
6 complications
- chronicity
- persistent drainage
- joint stiffness
- spreading infection
- gas gangrene
- gangrene
Subcutaneous abscess in hand
- site
- hair-bearing areas (boil, carbuncle)
3 Nail bed infections
+
predisposing factors
paronychia
eponychia
subungal abscess
common in those who work in damp environments
Felon
- site
- results from… 3
- digit pulp
- puncture wounds
paronychia
subungual abscess
webspace infections
(collar-button abscess)
when does it commonly occur
Common after spread of a infected palmar callus
Begins palmarly and spreads dorsally around transverse metacarpal ligament
CLOSED-SPACE INFECTIONS
- Name of sign tested
Kanaval’s sign
Radial and ulnar bursae infections
What is Parona Space?
Potential space between the deep flexor tendons and pronator quadratus
Septic arthritis WBC count
WBC count > 75 000 in aspirated fluid from joint
Human bite/clenched fist infections
- common organism
- treatment of choice
- Alpha-hemolytic Streptococcus
2. penicillin and Beta-lactamase inhibitor is antibiotic treatment of choice
Osteitis treatment principles
Drainage
IV antibiotics
Early mobilization
Herpetic infection
Herpes simplex common in children between 6 months and 6 years of age
Adults:
Medical and dental workers
Cancer
HIV
Lesions is self limited in nature
Recurrence in 20% of cases, reflecting the persistence of the virus in the anterior horn cells
MYCOBACTERIAL INFECTIONS
- Hand TB presentation
- Flexor/extensor chronic tenosynovitis, Septic arthritis of joint/ dactylitis
HIGH PRESSURE INJECTION INJURIES
Most common site is pad of the thumb or index finger
Pressure > 7 000 psi - 100% amputation
Digits: tendon sheaths - poor prognosis
NECROTIZING FASCIITIS
Should be kept in mind as unusual cases: Clostridia Anthrax ( farm related infections ) Brucellosis ( farm related ) Erysipelas ( in butchers ) Gonorrhoea and Syphyilis Protozoa infections ( Leishmaniasis ) Cat - scratch disease ( by Chlamydia )
