Felon

Updated: Mar 25, 2024
  • Author: Brandon Stein, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Overview

Background

Felons are closed-space infections of the fingertip pulp. [1, 2, 3]  

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Pathophysiology

Fingertip pulp is divided into numerous small compartments by vertical septa that stabilize the pad. Infection occurring within these compartments can lead to abscess formation, edema, and rapid development of increased pressure in a closed space. This increased pressure may compromise blood flow and lead to necrosis of the skin and pulp. The infection may lead to osteomyelitis and other serious life- and limb-threatening diseases. [1]  

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Epidemiology

Frequency

United States

Felons may account for up to 15% to 20% of all hand infections; howevever, a large retrospective review found this infection accounting for 5% of all hand infections that underwent incision and drainge. [4]  Therefore, it is likely that they account for an even smaller number of hand infections. The thumb and second digit are the most commonly affected digits. Often, a felon may develop from a localized fingertip infection such as a paronychia. 

Mortality/Morbidity

Left untreated, osteomyelitis, tenosynovitis, and septic arthritis may result. In addition, the infection can lead to fingertip destruction through spontaneous decompression toward the skin. 

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Prognosis

Given the severity of the pain and swelling patients usually present within the first several days and have a favorable prognosis. With early treatment, the prognosis is excellent with possible minor complications such as pain, sensitivity of the fingertip, pulp atrophy and deformity.

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