Infections of the hand: an overview

Abstract

Infections of the hand are common entities that are frequently encountered by orthopaedic surgeons and primary care physicians.A high clinical suspicion and a thorough medical history with information about the social and working history of the patients, correct identification of the type and cause of the infection, and prompt initiation of appropriate treatment by the infectious diseases physicians and orthopaedic surgeons are required.Late diagnosis and inappropriate treatment may be a significant cause of morbidity for the hand and mortality for the patients. This article reviews the clinical spectrum and microbiology of the most common infections of the hand, and discusses the current concepts for their treatment. The aim is to increase the awareness of the treating physicians of the diagnosis and management of infections in the hand. Cite this article: EFORT Open Rev 2019;4:183-193. DOI: 10.1302/2058-5241.4.180082.

Keywords: felon; granuloma; hand; infections; necrotizing fasciitis; osteomyelitis; paronychia; septic arthritis.

Fig. 1

Clenched fist bite wound at the dorsum of the hand after a fight injury.

Fig. 2

Infected dog bite wound at the palm.

Fig. 3

Acute paronychia requiring drainage in (a) a child and (b) an adult.

Fig. 4

(a) Dorsal and (b) palmar view of the middle finger show a felon with abscess formation.

Fig. 5

(a) Dorsal and (b) palmar views of the hand show flexor tenosynovitis of the middle finger treated with open surgical drainage and debridement.

Fig. 6

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

Fig. 7

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

Fig. 8

Cellulitis of the upper extremity.

Fig. 9

Granuloma formation after a foreign body at the middle finger.