Hand infections

1. In
min
20

2. Outline
• Paronychia
• Pulp space infections(Felon)
• Herpetic whitlow
• Septic arthritis/osteomyelitis
• Deep space infections
• Tendon sheath infection
• Infections from bite wounds
• Atypical mycobacterium infections
• The More

3. ANATOMY

4. Why ?
 Purulence  destroys gliding  adhesions  loss of function
 destroys the blood supply producing tendon necrosis

5. Acute paronychia

6. https://www.youtube.com/watch?v=BzarVK_7Jsk

7. FELON

8. HERPETIC WHITLOW

9. SEPTIC ARTHRITIS
Clinical photograph and (b) radiograph of the hand show septic
arthritis of the fourth metacarpophalangeal joint after trauma.

10. (a) Clinical photograph and (b) radiograph of the hand show
osteomyelitis of the distal phalanx of the index in a patient
with diabetes mellitus.

11. DEEP SPACE INFECTION

12. TENDON SHEATH INFECTION

13. FLEXOR TENOSYNOVITIS
Kanavel’s signs

14. FTS TREATMENT
 < 48 hrs  May use IV Abx + splinting + elevation
Failure to respond in 24 hrs. = drainage
 >48 hrs  SURGICAL EMERGENCY
 Open drainage / Closed tendon-sheath irrigation
Delays may result in tendon
&/or skin necrosis

15. Bites, human and animal
• Not to be closed
• Surgical toilet is vital.
• IV Treatment for 14 days
• Assess for tetanus/rabies/ virus risk.
• frequently not closed after
treatment so that any infection can
drain out,
• Deep structures > Surgical trimming

17. lost use of hand
despite 16
operations after
cat nipped her
• https://www.mirror.co.uk/news/uk-news/woman-who-lost-use-wounded-13374119

18. https://www.foxnews.com/health/rattlesnake-bite-finger

19. Viral infections

20. ATYPICAL INFECTIONS
• Gradual swelling and
stiffness without much
pain or redness
• Immunosuppressed mainly

21. https://www.mayoclinic.org/diseases-conditions/anthrax/symptoms-causes/syc-20356203

22. laboratory risk indicator for necrotizing
fasciitis (LRINEC)
• a score greater than 8 indicates greater than 75% chance of
having an NSTI
• the LRINEC score had a sensitivity of 80%, specificity of 67%,
https://pubmed.ncbi.nlm.nih.gov/19681416/
Laboratory Marker Results Score
C-reactive protein >= 150 mg/L 4
White blood cell 15,000e25,000/mL
> 25,000/mL
1
2
Hemoglobin 11e13.5 g/dL 1
< 11 g/dL
1
2
Sodium < 135 mmol/L 2
Creatinine > 1.6 mg/dL 2
Glucose > 180 mg/dL 1

23. DISCUSSION

24. Thank you..
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