Current concepts in hand infections

Excerpt

Hand infections are common occurrences, usually resulting from an injury, that when left untreated can quickly lead to tissue destruction and loss of function or permanent disability. Infections may be categorized anatomically: superficial, involving the tendon and tendon sheath, involving joint or bone, or affecting the deep spaces of the hand. Infections may be caused by different microorganisms, and, increasingly, by community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Currently MRSA accounts for as much as 65% of Staphylococcus aureus isolates, complicating the course of medical treatment. Brown and Young state that major metropolitan hospitals should expect 25-50 admissions annually for serious hand infection. Hand infections primarily occur after delayed treatment after minor trauma. Laceration, unknown causation, thorn, human bite (e.g., often “fight-bite” injuries), IV injection injury, dog bite, insect bite, blunt trauma, cat bite, snake bite, and pressure injections. The palm or dorsum of the hand, the middle finger and the index finger are most frequent locations of infection. It is reported that the most common hand infections are cellulitis and paronychia/eponychia (70%) and more severe infections such as septic arthritis and osteomyelitis occur less often (3%). …