A felon is a subcutaneous abscess of the distal pulp a phalanx, characterized by multiple vertical and fibrous trabeculae or septa. Often, a penetrating injury precedes the felon; pain and swelling develop quickly thereafter. The most common cause of the initial cellulitis is Staphylococcus aureus. The felon must be incised and drained; post-operative management includes systemic antibiotics and splinting. If left untreated, the felon can extend toward the phalanx, causing an osteitis or osteomyelitis or toward the skin, leading to necrosis and a sinus on the palmar surface of the digital pulp. Other complications of untreated felon include sequestration of the diaphysis of the distal phalanx and pyogenic arthritis of the distal interphalangeal (DIP) joint.
Related Anatomy
Incidence and Related Conditions
Differential Diagnosis
A 43-year-old right-handed male was building a deck in his backyard 10 days ago when he punctured the tip of his left index finger with a splinter of wood. He removed the splinter himself with his jack knife. He thought that he had removed all the splinter fragments. He was fine for a few days but then the fingertip began to get sore and swell. He now presents with throbbing pain in the pulp of the left index finger. The pulp of the finger is tense, red and very painful. The redness at the fingertip appears to be increasing and spreading onto his left hand. He has had no treatment except for removing the splinter and soaking the finger.
Early incision and drainage of a felon combined with antibiotic treatment usually provides an excellent outcome. If the patient has complicating factors such as diabetes mellitus or if the care is delayed, then the simple felon can be complicated by distal phalanx osteomyelitis, DIP joint infection or necrosis of the pulp skin.
New articles
Reviews
Classics
