Pulp Space Infections



Pulp Space Infections


Omri Ayalon

Matthew B. Cantlon



INTRODUCTION



  • Definition—Infection contained in the closed and unyielding septal spaces of the distal volar pad of the finger or thumb. Also referred to as a “felon.”


  • Epidemiology—Represents up to 20% of all hand infections1 and 6% of all incision and drainage procedures performed on the hand.2


  • Mechanism of injury



    • Vast majority of injuries arise from prior lacerations or penetrating trauma such as wooden or metal splinters or glass (Figure 42.1). Injuries can occur in diabetics from repeated glucose finger-stick testing.


    • Eccrine sweat glands may become colonized with bacteria that occasionally lead to a pulp space infection.


    • Local inoculation from underlying osteomyelitis may also occur.



  • Microbiology



    • Staphylococcus aureus is the most common (75% of all hand infections). Methicillin-resistant S. aureus (MRSA) is now more common than methicillin-susceptible S. aureus in most urban centers.2 Risk factors for MRSA include immunocompromised status, HIV infection, diabetes, intravenous drug use, and being a health care worker.3,4


    • Polymicrobial infection is the next most common, followed by Streptococcal species.2


    • Gram-negative species may occur in diabetics and immunocompromised individuals.






FIGURE 42.1 Pulp space infection from a penetrating trauma.


PATHOANATOMY

May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Pulp Space Infections
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