Orthopedics – Infections
1. Why are infections uncommon in the hand?: - due to good blood supply
2. What are RFs for hand infections?: - diabetes
- fight bites
3. What is the MCO for hand infections?: - MCO = Staph aureus
4. Which digits do the epitrochlear nodes drain?: - ring and small finger
5. Which digits do the axillary nodes drain?: - radial digits
6. How is pus under pressure treated in hand infections?: - surgical drainage
7. How is cellulitis treated?: - Surgical drainage and IV antibiotics
8. What is the MC infection of the hand?: MC is Paronychia/Eponychia
- infection of the nail bed is paronychia with purulence around cuticle
- eponychia involves the entire eponychium and lateral fold
1/8
,9. How is paronychia or eponychia treated?: 1. I&D to include partial nail removal, loose packing,
soaks, and ORAL antibiotics
10. What is a felon infection?: Felon = subcutaneous abscess of the distal finger pulp
11. How is a felon infection treated?: 1. I&D with lateral and ulnar incision and disruption of septae
- avoid nerves, vessels, and flexor tendon sheath
- if thumb and small finger, use lateral and radial incisions
2. IV or oral antibiotics
12. What is the MC location of human bite hand infections?: MC is 3rd or 4th MCP joint
13. What is the MCO for fight bite infections?: MCO = Staph aureus, but cover Eikenella corrodens
14. How are human bite hand infections treated?: 1. If it involves the joint, may need formal I&D
2. Antibiotic coverage for S. aureus and for Eikenella corrodens -> Penicillin or Augmentin
3. Tetanus prophylaxis
15. How should you treat a dog or cat bite?: 1. Augmentin to cover Pasteurella multocida (-)
2. I&D required IF joint or flexor sheath penetration
3. Tetanus prophylaxis
2/8
, 16. What is the MCO for dog or cat bite infections?: - Pasteurella multocida
17. What is suppurative flexor tenosynovitis?: - infection of the flexor tendon sheath
18. What are Kanavel's four cardinal signs for suppurative flexor tenosynovitis?: -
pain on passive extension of the digit is an EARLY sign
- finger held in FLEXED position
- severe tenderness along the tendon sheath
3/8
1. Why are infections uncommon in the hand?: - due to good blood supply
2. What are RFs for hand infections?: - diabetes
- fight bites
3. What is the MCO for hand infections?: - MCO = Staph aureus
4. Which digits do the epitrochlear nodes drain?: - ring and small finger
5. Which digits do the axillary nodes drain?: - radial digits
6. How is pus under pressure treated in hand infections?: - surgical drainage
7. How is cellulitis treated?: - Surgical drainage and IV antibiotics
8. What is the MC infection of the hand?: MC is Paronychia/Eponychia
- infection of the nail bed is paronychia with purulence around cuticle
- eponychia involves the entire eponychium and lateral fold
1/8
,9. How is paronychia or eponychia treated?: 1. I&D to include partial nail removal, loose packing,
soaks, and ORAL antibiotics
10. What is a felon infection?: Felon = subcutaneous abscess of the distal finger pulp
11. How is a felon infection treated?: 1. I&D with lateral and ulnar incision and disruption of septae
- avoid nerves, vessels, and flexor tendon sheath
- if thumb and small finger, use lateral and radial incisions
2. IV or oral antibiotics
12. What is the MC location of human bite hand infections?: MC is 3rd or 4th MCP joint
13. What is the MCO for fight bite infections?: MCO = Staph aureus, but cover Eikenella corrodens
14. How are human bite hand infections treated?: 1. If it involves the joint, may need formal I&D
2. Antibiotic coverage for S. aureus and for Eikenella corrodens -> Penicillin or Augmentin
3. Tetanus prophylaxis
15. How should you treat a dog or cat bite?: 1. Augmentin to cover Pasteurella multocida (-)
2. I&D required IF joint or flexor sheath penetration
3. Tetanus prophylaxis
2/8
, 16. What is the MCO for dog or cat bite infections?: - Pasteurella multocida
17. What is suppurative flexor tenosynovitis?: - infection of the flexor tendon sheath
18. What are Kanavel's four cardinal signs for suppurative flexor tenosynovitis?: -
pain on passive extension of the digit is an EARLY sign
- finger held in FLEXED position
- severe tenderness along the tendon sheath
3/8
