Hand Case 14 ED Management
X rays should be ordered to evaluate for retained foreign body and osteomyelitis. Evaluate tetanus immunization status.
If there is minimal swelling, the felon is likely in its early stages and can be treated with elevation, warm soaks, and oral antibiotics with rapid follow up for reassessment. Make sure to cover for MRSA. Consider additional GNR coverage as dictated by the clinical scenario.
If there is significant swelling, an I&D should be performed. Several techniques have been described (longitudinal, lateral, “hockey stick”, “fish mouth”). What these all have in common is that they must dissect deep enough to break up the fibrous septae to get to all possible loculations of purulence . The patient can then be loosely packed or a drain can be placed, splinted, and sent home with oral antibiotics and saline soaks.