Dr. Wahby Ghalib CABO, FJMC, MRCS
Infection of nail fold Predisposition : DM exposure to water or irritants S. aureusABCAbscess drainage by incision at the angle of the nailSubungual abcess remove the nail
Abscess Chronic paronychia : inadequate Rx or fungal infection Osteomyelitis
Pulp space is closed space filled with fat and subdivided by fibrous septa It contains terminal branch of the digital artery that supplies distal phalanxFollows prick injury S. Aureus Rx : ABC drainage
Spread of infection : bone, joint or flexor tendonThrombosis of digital a. necrosis of distal phalanxFPL synovial sheath (radial bursa): from wrist to its insertion Common flexor synovial sheath ( ulnar bursa) Distally ends blindly at level of proximal crease Except at little finger Separate synovial sheaths for the middle 3 digits
In 50 % of people ulnar & radial bursae communicate Space of Parona : fascial space between FDP anteriorly & PQ & interosseous membrane posteriorly
Cardinal signs of Kanavel
Sausage - like swelling Finger held in flexion Painful passive extension Tenderness along the course of tendonInfection follows penetrating injuryS. aureus Rx : ABC IF no response after 24 hrs drainage
Tendon necrosis Spread of infection : ulnar and radial bursae space of Parona Median nerve compression
2 deep spaces in the hand by an oblique septum between palmar aponeurosis & 3rd MCB Midpalmar & thenar Contain flexor tendons & lumbricals
Penetrating injury Spread from web space or tendon sheath S. aureus Pain & swelling in the dorsal aspect Rx : ABC drainage
S. aureus If no response to ABC after 24 hr drainage
May be infected : Staphylococci or Streptococci Dogs & cats : consider Pasturella multocida (G-ve rods)Staphylococci or Streptococci Eikenella corrodens Rx : ABC debridement