II. Definition

  1. Infection of closed space of distal phalanx pulp

III. Mechanism: Local finger tip Puncture Wound

  1. Splinter
  2. Glass fragment
  3. Punctures (e.g. Finger-stick Blood Sugar testing)

IV. Symptoms

  1. Rapidly increasing pressure and pain at finger tip
  2. Thumb and index finger most commonly affected

VI. Complications

  1. Osteomyelitis of distal phalanx
  2. Contiguous spread
    1. Pyogenic Flexor Tenosynovitis
    2. Infection of adjacent joint

VII. Management: Conservative measures

  1. Tetanus prophylaxis
  2. Warm soaks
  3. Antibiotics for 5 to 14 days
    1. Cephalexin (Keflex) or
    2. Dicloxacillin

VIII. Management: Early Incision and Drainage

  1. Indications
    1. No improvement after 24 hours conservative therapy
  2. Contraindications
    1. Herpetic Whitlow
  3. Anesthesia
    1. Digital Block (Metacarpal Block)
  4. Technique
    1. Apply Tourniquet at base of finger
    2. Identify point of maximal tenderness and swelling
      1. Make 5-10 mm incision using method below
    3. No specific point of tenderness
      1. Make straight single volar or high lateral incision
        1. Start incision 3-5 mm distal to DIP joint
        2. Keep lateral incision within 5 mm of nail border
        3. Continue incision distally to distal phalanx tip
        4. Thumb and pinky finger: Incise radial side
        5. Index, long and ring fingers: Incise ulnar side
      2. Avoid incision methods with higher risk of scar
        1. Transverse palmar incision
        2. J-shaped incision
        3. Fish mouth incision
    4. Wound exploration
      1. Gently open subcutaneous tissue with hemostat
      2. Irrigate wound
      3. Pack with sterile gauze for 48 hours
  5. Complications
    1. Painful neuroma
    2. Finger pad instability
    3. Scarring

IX. Follow-up care

  1. Splint and elevate for 48 hours
  2. Saline soaks twice daily
  3. Maintain range of motion
  4. Anticipate healing in 2 weeks

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Ontology: whitlow (C0152448)

Concepts Pathologic Function (T046)
ICD9 681.01
ICD10 L03.01
SnomedCT 200632003, 156304001, 267829005, 32021005
English Finger pulp abscess, felon, felon (diagnosis), whitlows, (Finger pulp abscess) or (felon) or (whitlow) (disorder), Felon - whitlow, (Finger pulp abscess) or (felon) or (whitlow), Felon, Whitlow, Pulp abscess of finger, Pulp abscess of finger (disorder), Pulp abscess of finger, NOS, whitlow
Dutch fijt, whitlow
French Panaris pulpaire, Panaris
German Umlauf, Verbrecher
Italian Patereccio
Portuguese Panarício
Spanish Panadizo, absceso de la yema de dedo de la mano (trastorno), absceso de la yema de dedo de la mano
Japanese ひょう疽, ヒョウソ
Czech Herpetická vyrážka na ruce, Panaricium
Hungarian körömágygyulladás, Körömágy gyulladása