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Felon (Fingertip Pulp Infection)

46 citationsUpdated Oct 2026
Illustration: Felon (Fingertip Pulp Infection)

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Paronychias and felons represent the most common hand infections [5]. These conditions are part of a diverse array of hand pathologies that carry a potential for serious morbidity [4]. Because hand infections are associated with a high rate of complications that are often difficult to manage [8], early identification and treatment are essential to achieve optimal outcomes [2]. Delayed diagnosis can result in amputation or death [2], while prompt intervention is required to preserve the digit and prevent the loss of hand function [6]. The morbidity of these infections can be decreased through an understanding of the different types of hand infections, which are often unique to the particular anatomy of the hand [9].

Accurate diagnosis and effective management of deep space infections rely on a high index of suspicion coupled with excellent knowledge of hand anatomy and function [14]. Emergency physicians must be familiar with the management of finger felons and paronychias to ensure appropriate care [1]. While atypical hand infections are difficult to recognize and treat due to their indolent nature and nonspecific symptoms [11], early identification through appropriate laboratory testing and surgical treatment paired with medical management is imperative for eradication of the causative organism [11]. Osteomyelitis of the hand is uncommon but can have devastating effects on hand function if not adequately and promptly treated [7]. Management of osteomyelitis of the hand and wrist should consist of a combined surgical and medical approach to achieve the most favorable outcome [15].

Postoperative management varies based on patient risk and infection location. Antibiotics are not needed in the postoperative phase after excision of uncomplicated paronychia and felon in patients who are not at risk [10]. For dorsal hand infections, an initial debridement at the bedside is at least as effective as formal debridement in the operating room [50]. This bedside approach decreases the number of formal debridements and hospital days without increasing complications [50].

Anatomy & Pathophysiology

Fingertip Pulp Anatomy

The distal digital pulp is a tight septal compartment divided into tiny spaces by strong fibrous septa that traverse from the skin to the bone [41, 67]. A transverse fibrous curtain is present at the distal flexor finger crease [41]. Because of these fibrous septa, any swelling within the pulp results in immediate pain due to increased pressure [41]. The epiphysis of the distal phalanx receives a separate blood supply and is not involved in early cases of felon [34].

Pathogenesis and Progression

Felons are among the most common infections of the distal phalanx [34]. Infection typically originates from a penetrating injury involving a foreign body or from "finger sticks" for medical reasons [41]. S. aureus is the organism most commonly isolated from these fingertip infections [41, 67].

Two theories explain the pathogenesis of bone necrosis in felons. Kanavel contends that pressure from edema or pus in closed space infections shuts off the blood supply to the bone, causing necrosis [34]. Roux's theory claims that lymphatic vessels run perpendicular from the skin to the periosteum, lifting it off the bone and causing necrosis; however, the very firm attachment of the periosteum to the bone is cited as evidence against this mechanism [34].

The initial presentation includes swelling, redness, and pain typical of cellulitis, with abscess formation potentially following rapidly [41]. If a felon lesion is relatively superficial, the purulence may "point" palmarly, a condition known as an apical abscess [67]. Without treatment or with inadequate treatment, complications include spontaneous fistulization or diffusion of the infection into anatomical spaces such as the synovial sheath, joints, tendon, bone, or cartilage [32]. Specific complications of a felon include loss of pulp tissue, osteomyelitis, epiphyseal damage, and septic arthritis [67]. In a series of 330 fingertip infections, observed complications occurred in 5% of cases [32].

Clinical Presentation and Diagnosis

Felons are recognized clinically by intense pain, erythema, and palmar swelling of the fingertip [67]. The diagnosis of an abscess in the fingertip area is sometimes difficult, but an abscess is usually present if severe pain has lasted for 12 hours or longer [41]. Hand and upper-extremity infections are usually a clinical diagnosis, but imaging and laboratory evaluation aid in diagnosis [26].

A pulp abscess can extend into the periosteum around the nail bed, causing paronychia [41]. It can also extend proximally through the fibrous curtain into the flexor sheath, leading to flexor tenosynovitis [41]. Abscesses beginning deep in the pulp, especially if untreated, can penetrate the periosteum and cause osteomyelitis or septic joint [41]. More superficial abscesses in the pulp can cause skin necrosis [41].

Classification

Epidemiology: Fingertip infections constitute approximately one-third of all hand infections [32]. In a literature review, felon specifically represented 15% of hand infections [32]. Other common presentations included cellulitis and paronychia, which each represented 35% of cases [32]. Less frequent diagnoses included synovial sheath infection (10%), hand abscesses (2%), osteo-arthritis (2%), and osteitis (1%) [32].

Microbiological Grouping: Chronic hand infections are categorized by microorganism into bacterial (mycobacterial and others), fungal, and viral types [17]. Herpetic whitlow is a viral infection of the hand caused by HSV-1 and -2 [31]. The terms 'whitlow' and 'felon' refer to distinct conditions in the context of herpetic whitlow [31]. Consequently, the term 'felon' is not representative of the presentation or the treatment of herpetic whitlow [31].

Other Considerations: Acute felon is an unusual but aggressive manifestation of taxane-related nail dystrophy [23]. It must be distinguished from chronic subungual abscesses in immunocompromised patients [23]. Pilonidal sinus is an acquired chronic inflammatory condition associated with the penetration of hair fragments into the skin [25]. While pilonidal sinus of the interdigital spaces of the hand is a well-recognised occupational disease of male barbers [25], pilonidal sinus of the finger pulp is a previously unreported site for this condition [25].

Clinical Presentation

Anatomy and Pathophysiology

A felon is defined as an abscess located in the subcutaneous tissues of the distal pulp of a finger or thumb [41]. The distal digital pulp is compartmentalized by strong fibrous septa that traverse from skin to bone [41]. Swelling within these compartments causes immediate pain, which is intensified by increased pressure within the pulp [41]. Infection typically originates from a penetrating injury involving a foreign body or from medical "finger sticks" used for hematocrit and blood glucose determinations [41]. Abscesses may occasionally form in the middle and proximal digital pulps [41].

Clinical Signs and Diagnosis

Initial presentation includes swelling, redness, and pain typical of cellulitis, with abscess formation potentially following rapidly [41]. Chronic hand infections are uncommon and require a high index of suspicion for early diagnosis [17]. Herpetic whitlow presents with a single vesicle or cluster of vesicles arising on a single digit days after minor trauma [31]. These vesicles coalesce to form a larger bulla similar in appearance to a bacterial felon or paronychia [31]. Herpetic whitlow is distinguished from bacterial felon by the formation of nonpurulent vesicles or bullae [31]. It maintains tension in the pulp space, which is not increased unless secondary bacterial infection is present [31].

Mimics and Differential Diagnosis

Metastatic bronchogenic carcinoma can masquerade as a felon due to subcutaneous swelling, necrosis, and exudate from the distal phalanx [33]. Pilonidal sinus of the finger pulp presents with discharging sinuses in the distal pulp space and is an acquired chronic inflammatory condition associated with the penetration of hair fragments into the skin [25]. Acute felon is an unusual but aggressive manifestation of taxane-related nail dystrophy that must be distinguished from chronic subungual abscesses in immunocompromised patients [23]. Tularemia infection should be considered when a hand infection persists, particularly in the context of an animal bite [13]. Acute Nocardia infection of the hand should be considered in children with suppurative infections that do not respond to initial treatment [76]. Isolated Kaposi sarcoma of the finger pulp can occur in AIDS patients even in the absence of associated systemic lesions [36].

Risk Factors and Comorbidities

Diabetic patients are more likely to present with infections from unknown or idiopathic mechanisms compared with nondiabetic patients [42]. They more frequently present with osteomyelitis, septic arthritis, and necrotizing fasciitis than nondiabetic patients [42]. Diabetic individuals are more frequently managed as inpatients subsequently compared to nondiabetic patients [42]. After first drainage, diabetic patients are substantially more likely to require repeat drainage than nondiabetic patients [42]. Among inpatients, those who are diabetic are more likely to undergo eventual amputation than nondiabetic patients [42]. Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections [22]. Hand infections in immunocompromised patients, including those with HIV/AIDS, diabetes, or on immunosuppressive treatment, present with specific clinical pictures and possible complications [35]. Pediatric hand infections have unique characteristics including the frequency of fingers in mouths, open growth plates, and typically more robust circulation with fewer systemic comorbidities [16].

Complications and Prognosis

The felon abscess can extend into the periosteum around the nail bed causing paronychia [41]. It can also extend proximally through the fibrous curtain into the flexor sheath, leading to flexor tenosynovitis [41]. Pyogenic flexor tenosynovitis is a relatively common but often misdiagnosed hand infection [47]. Several signs of shock and organ dysfunction were associated with mortality in patients with necrotizing soft tissue infections of the extremities [45].

Investigations

Clinical Diagnosis and History: A careful physical examination is essential to direct care and future testing if indicated [38]. Diagnostic tests such as imaging and serum laboratory studies are useful in the determination of pathology but can be expensive, time consuming, and often nonspecific [38]. Early identification through appropriate laboratory testing is imperative for the eradication of the causative organism in atypical hand infections [11]. Chronic hand infections require a high index of suspicion for early diagnosis [17].

Plain radiography: Initial roentgenographs may show a lack of intramedullary involvement in cases of metastatic bronchogenic carcinoma masquerading as a felon [33].

CT: Contrast-enhanced CT provides objective data to aid in the prompt diagnosis of acute pyogenic flexor tenosynovitis [93]. Radiographic soft tissue thickness can be used to differentiate pyogenic flexor tenosynovitis from other finger infections, including felon [21].

Laboratory: Flexor tenosynovectomy provided material for histologic diagnosis in cases of sarcoid flexor tenosynovitis [44].

Treatment

Non-Operative

Prompt recognition and appropriate treatment are required to minimize morbidity and expedite recovery [22]. An outpatient management strategy is appropriate for many infections and minimizes excess healthcare expenditures [22]. For selected patients, outpatient management of diabetic hand infections provides a safe alternative to inpatient admission [91].

Operative

Indications: The management of felon is based entirely on tradition and expert opinion, with no primary data regarding management found in the literature [19]. Early diagnosis and prompt treatment are required to preserve the digit and prevent morbidity and loss of hand function in pyogenic flexor tenosynovitis [6]. Atypical hand infections require early identification through appropriate laboratory testing and surgical treatment paired with medical management for eradication of the causative organism [11].

Surgical Approach / Technique: A midline incision for felon does not divide the perpendicular connective tissue fibers which attach the skin to the periosteum [34]. In contrast, a fish-mouth incision provides efficient drainage but is followed by a deep furrowed scar which seriously interferes with the use of the finger-tip for the performance of fine acts [34]. The fish-mouth incision is unduly long in healing and leaves a painful scar over the finger-tip, and also an anesthetic area distal to the scar [34]. The lateral hockey-stick type of incision fulfills the purpose of adequate drainage [34]. An initial debridement of dorsal hand infections at the bedside is at least as effective as formal debridement in the operating room, decreasing the number of formal debridements and hospital days without increasing complications [50]. Effective treatment of mucormycosis osteomyelitis is predicated upon prompt recognition, early aggressive debridement, and appropriate antimicrobial coverage [30]. Early amputation to maximize disease-free survival may be appropriate for patients with hand osteomyelitis and arterial calcification [20].

Adjuncts: A prospective multicenter trial showed no significant difference in infection rate in elective hand surgery whether antibiotics were administered preoperatively or not [48].

Other Considerations: Physicians should bear in mind the unique environments and characteristics of the pediatric hand, including the frequency of fingers in mouths, open growth plates, and typically more robust circulation with fewer systemic comorbidities [16].

Complications

Surgical Failure and Follow-up: In a cohort of 652 patients with hand infections, 84 revision procedures were required in 72 patients [24]. Additionally, 112 patients (17%) did not attend the postoperative clinic appointment and were lost to follow-up [24].

Severe Infection and Systemic Risk: Delayed diagnosis of hand infections can result in amputation or death [2]. Osteomyelitis of the hand can have devastating effects on hand function if not adequately and promptly treated [7]. Pyogenic flexor tenosynovitis requires early diagnosis and prompt treatment to prevent morbidity and loss of hand function [6].

Other Considerations: Acute felon is an aggressive manifestation of taxane-related nail dystrophy that must be distinguished from chronic subungual abscesses in immunocompromised patients [23]. Incision and drainage in herpetic whitlow is contraindicated because it can potentially lead to secondary bacterial infection [31]. Herpetic whitlow has a higher prevalence in HIV-positive patients and has been reported to be the first manifestation of previously undiagnosed HIV [31]. Metastatic bronchogenic carcinoma can masquerade as a felon, presenting with subcutaneous swelling, necrosis, and exudate from the distal phalanx [33].

Recovery

Light activity (weeks): The lateral-ungual approach with nail bed or finger pulp flap results in normal function recovery in 3 weeks [12]. This timeframe covers the initial return to desk work, driving, and light activities of daily living.

Full activity (months): Evidence does not specify a distinct month range for the return to manual work or sport.

Complete recovery / outcome plateau (months): Evidence does not specify a distinct month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: Whenever the tuft of the phalanx is removed early in a case of infection of the anterior space, the healing period is shortened [27].

Functional milestones: The lateral-ungual approach with nail bed or finger pulp flap results in no wound infections or nail deformities [12]. After 2 and a half years, treatment of digital pyogenic flexor tenosynovitis yielded high patient satisfaction with neither functional nor subjective impairment of the affected finger [29].

Other Considerations: Early identification and treatment of hand infections are essential to achieve optimal outcomes [2]. Prompt diagnosis and early debridement are of the utmost importance to improve outcomes for invasive Group A Streptococcus hand infections [37]. Effective treatment of mucormycosis osteomyelitis of the hand is predicated upon prompt recognition, early aggressive debridement, and appropriate antimicrobial coverage [30]. In a study of 652 patients presenting with a hand infection, 331 cases were felons [24]. Within this cohort, 112 patients (17%) did not attend the postoperative clinic appointment and were lost to follow-up [24]. Additionally, 84 revision procedures were required in 72 patients [24]. Regarding comorbidities, 134 of 485 tested patients (28%) were HIV positive [24]. Of the 75 HIV-positive patients with known CD4 counts, 53 (71%) had a CD4 count above 200 [24], while 22 (29%) had a CD4 count below 200 [24]. Of the 22 patients with a CD4 count below 200, two patients had revision surgery and one had an unspecified outcome [24].

Key Evidence

  • [L5] It is essential for emergency physicians to be familiar with the management of finger felons and paronychias. [1] (10.1016/j.jemermed.2025.07.054)
  • [L5] Early identification and treatment of hand infections are essential to achieve optimal outcomes, as delayed diagnosis can result in amputation or death. [2] (10.1016/j.jhsa.2018.05.027)
  • [L5] Hand infections include a diverse array of entities with potential for serious morbidity. [4] (10.1016/j.jhsa.2011.05.035)
  • [L5] Paronychias and felons are the most common hand infections. [5] (10.1016/s0749-0712(21)00416-9)
  • [L5] Early diagnosis and prompt treatment are required to preserve the digit and prevent morbidity and loss of hand function. [6] (10.1016/j.hcl.2020.03.005)
  • [L5] Osteomyelitis of the hand is uncommon but can have devastating effects on hand function if not adequately and promptly treated. [7] (10.1177/1753193415612373)
  • [L5] Hand infections are associated with a high rate of complications that are often difficult to manage. [8] (10.1016/j.hcl.2020.03.010)
  • [L5] The morbidity of hand infections can be decreased with understanding of the different types of hand infections often unique to the particular anatomy of the hand. [9] (10.5435/00124635-199607000-00006)
  • [L2] The findings confirm that antibiotics are not needed in the postoperative phase after excision of uncomplicated paronychia and felon in patients who are not at risk. [10] (10.1016/j.hansur.2015.12.003)
  • [L4] Atypical hand infections are difficult to recognize and treat due to their indolent nature and nonspecific symptoms; early identification through appropriate laboratory testing and surgical treatment paired with medical management is imperative for eradication of the causative organism. [11] (10.1016/j.jhsa.2025.09.023)
  • [L4] The lateral-ungual approach with nail bed or finger pulp flap allows full access to the subungual or finger pulp region without disturbing nail bed organization, resulting in significant pain improvement, normal function recovery in 3 weeks, and no wound infections or nail deformities. [12] (10.1177/1753193410397980)
  • [Case_report] The purpose of this case study is to alert treating providers to consider tularemia infection when a hand infection persists, particularly in the context of an animal bite. [13] (10.1016/j.jhsg.2020.07.001)
  • [L5] A high index of suspicion coupled with an excellent knowledge of hand anatomy and function allows for an accurate diagnosis and effective management of deep space infections. [14] (10.1016/j.hcl.2020.03.014)
  • [L5] Management of osteomyelitis of the hand and wrist should consist of a combined surgical and medical approach to achieve the most favorable outcome. [15] (10.1016/j.jhsa.2009.03.020)
  • [L5] Although many management principles are the same in pediatric and adult patients, physicians should bear in mind the unique environments and characteristics of the pediatric hand, including the frequency of fingers in mouths, open growth plates, and typically more robust circulation with fewer systemic comorbidities. [16] (10.1016/j.hcl.2020.03.012)
  • [L5] Chronic hand infections are uncommon and require a high index of suspicion for early diagnosis; they are grouped by microorganism into bacterial (mycobacterial and others), fungal, and viral types, with specific presentations and treatments emphasized for each. [17] (10.1016/j.jhsa.2014.04.003)
  • [L5] The management of felon is based entirely on tradition and expert opinion, with no primary data regarding management found in the literature. [19] (10.1016/j.jhsa.2012.08.002)
  • [L4] Early amputation to maximize disease-free survival may be appropriate for patients with hand osteomyelitis and arterial calcification. [20] (10.1177/1753193420981871)
  • [L4] [21] (10.1016/j.jhsa.2019.01.013)
  • [L3] [22] (10.1186/s13018-023-03911-5)
  • [Case_report] Acute felon is an unusual but aggressive manifestation of taxane-related nail dystrophy that must be distinguished from chronic subungual abscesses in immunocompromised patients. [23] (10.1007/s11552-007-9029-3)
  • [L3] [24] (10.1177/1753193420977791)
  • [L4] [25] (10.1054/jhsb.2001.0580)
  • [L5] Hand and upper-extremity infections are usually a clinical diagnosis, but imaging and laboratory evaluation aid in diagnosis. [26] (10.1016/j.hcl.2020.03.002)
  • [L4] Whenever the tuft of the phalanx is removed early in a case of infection of the anterior space, the healing period is shortened. [27] (10.1001/archsurg.1942.01210240092006)
  • [L4] After 2 and a half years, the treatment yielded high patient satisfaction with neither functional nor subjective impairment of the affected finger. [29] (10.1007/s00402-016-2587-5)
  • [L4] Effective treatment is predicated upon prompt recognition, early aggressive debridement, and appropriate antimicrobial coverage. [30] (10.1016/j.jhsa.2018.04.034)
  • [L5] [31] (10.1016/j.hcl.2020.03.008)
  • [L4] [32] (10.1016/j.hansur.2020.12.011)
  • [L5] This patient was initially misdiagnosed as having a felon due to the subcutaneous swelling, necrosis, and exudate from the distal phalanx as well as the lack of intramedullary involvement on initial roentgenographs. [33] (10.1016/s0363-5023(83)80171-3)
  • [L4] [34] (10.1097/00000658-194001000-00013)
  • [L5] The purpose of this article is to provide an outline of the most common and some of the more exotic organisms causing hand infections in patients with human immunodeficiency virus/acquired immunodeficiency syndrome, diabetes, and patients on immunosuppressive treatment, discussing presentation, clinical picture, evidence-based approaches in treatment, and possible complications. [35] (10.1016/j.jhsa.2018.07.001)
  • [L5] This case highlights the importance of recognizing isolated phalangeal Kaposi sarcoma in hand surgeons even in the absence of associated systemic lesions. [36] (10.1016/j.otsr.2011.09.017)
  • [L4] Prompt diagnosis and early debridement are of the utmost importance to improve outcomes for these often limb- and life-threatening infections. [37] (10.1177/17531934241268983)
  • [L2] [42] (10.1016/j.jhsa.2017.11.003)
  • [L5] Flexor tenosynovectomy provided material for histologic diagnosis and increased the function of the hand. [44] (10.1016/s0363-5023(86)80160-5)
  • [L2] Several signs of shock and organ dysfunction were associated with mortality in patients with necrotizing soft tissue infections of the extremities. [45] (10.1097/01.blo.0000218734.46376.89)
  • [L5] Pyogenic flexor tenosynovitis is a relatively common but often misdiagnosed hand infection. [47] (10.1136/bcr-2012-006778)
  • [L2] Our prospective multicenter trial showed no significant difference in infection rate in elective hand surgery whether antibiotics were administered preoperatively or not. [48] (10.1177/1558944719842238)
  • [L3] An initial debridement of dorsal hand infections at the bedside is at least as effective as formal debridement in the operating room, decreasing the number of formal debridements and hospital days without increasing complications. [50] (10.1177/1558944719836234)
  • [L4] Acute Nocardia infection of the hand should be considered in children with suppurative infections that do not respond to initial treatment. [76] (10.1016/j.jhsa.2018.03.039)
  • [L4] Outpatient management of diabetic hand infections provides a safe alternative to inpatient admission in selected patients. [91] (10.1177/17531934231196026)
  • [L3] Contrast-enhanced CT provides objective data to aid in the prompt diagnosis of acute pyogenic flexor tenosynovitis. [93] (10.1177/15589447221092058)

See Also

References

[1] Management of Finger Felons and Paronychia: A Narrative Review. The Journal of Emergency Medicine. 2025. DOI: 10.1016/j.jemermed.2025.07.054

[2] Hand Infections. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.05.027

[4] Hand Infections. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.05.035

[5] INFECTIONS OF THE FINGERTIP. Hand Clinics. 1998. DOI: 10.1016/s0749-0712(21)00416-9

[6] Pyogenic Flexor Tenosynovitis: Evaluation and Management. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.005

[7] Osteomyelitis of the hand. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415612373

[8] Complications of Hand Infections. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.010

[9] Hand Infections: Treatment Recommendations for Specific Types. Journal of the American Academy of Orthopaedic Surgeons. 1996. DOI: 10.5435/00124635-199607000-00006

[10] Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients. Hand Surgery and Rehabilitation. 2016. DOI: 10.1016/j.hansur.2015.12.003

[11] Atypical Hand Infections. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.09.023

[12] The treatment of finger glomus tumours by raising a full thickness nail bed flap or finger pulp flap. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410397980

[13] Tularemia Hand Infection From a Cat Bite—A Case Report. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2020.07.001

[14] Hand Abscesses. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.014

[15] Current Recommendations in the Management of Osteomyelitis of the Hand and Wrist. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.03.020

[16] Pediatric Hand Infections. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.012

[17] Chronic Hand Infections. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.003

[19] Diagnosis and Management of the Acute Felon: Evidence-Based Review. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.08.002

[20] Hand osteomyelitis in arterial calcification, diabetes mellitus and end-stage renal failure: a comparison of 210 cases over 12 years. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193420981871

[21] Radiographic Soft Tissue Thickness Differentiating Pyogenic Flexor Tenosynovitis From Other Finger Infections. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.01.013

[22] Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03911-5

[23] Acute Felon as a Complication of Systemic Paclitaxel Therapy: Case Report and Review of the Literature. HAND. 2007. DOI: 10.1007/s11552-007-9029-3

[24] Factors affecting suboptimal outcomes in hand infections. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420977791

[25] Pilonidal Sinus of the Finger Pulp. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2001.0580

[26] Imaging and Laboratory Workup for Hand Infections. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.002

[27] END RESULTS OF A NEW INCISION FOR FELON (INFECTION OF THE ANTERIOR SPACE). Archives of Surgery. 1942. DOI: 10.1001/archsurg.1942.01210240092006

[29] Treatment of digital pyogenic flexor tenosynovitis: single open debridement, irrigation, and primary wound closure followed by antibiotic therapy. Archives of Orthopaedic and Trauma Surgery. 2016. DOI: 10.1007/s00402-016-2587-5

[30] Mucormycosis Osteomyelitis of the Hand. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.04.034

[31] Hand Infections Associated with Systemic Conditions. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.03.008

[32] Advanced finger infection: more frequent than expected and mostly iatrogenic. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2020.12.011

[33] Metastatic bronchogenic carcinoma masquerading as a felon. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80171-3

[34] NEW INCISION FOR CLOSED SPACE INFECTION (FELON) INVOLVING DISTAL PHALANX OF FINGER. Annals of Surgery. 1940. DOI: 10.1097/00000658-194001000-00013

[35] Hand Infections in the Immunocompromised Patient: An Update. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.07.001

[36] Isolated Kaposi sarcoma of the finger pulp in an AIDS patient. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2011.09.017

[37] A surge in the incidence of invasive Group A Streptococcus hand infections: a single Hand Unit experience. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241268983

[38] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[41] Campbell S Operative Orthopaedics 4 Volume Set. TUMORS AND TUMOROUS CONDITIONS OF THE HAND > FELON.

[42] Quantifying the Effect of Diabetes on Surgical Hand and Forearm Infections. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.11.003

[44] Sarcoid flexor tenosynovitis of the finger: A case report. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80160-5

[45] Necrotizing Soft Tissue Infections of the Extremities and Back. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218734.46376.89

[47] Pyogenic flexor tenosynovitis leading to an amputation. BMJ Case Reports. 2012. DOI: 10.1136/bcr-2012-006778

[48] Prospective Analysis of Hand Infection Rates in Elective Soft Tissue Procedures of the Hand: The Role of Preoperative Antibiotics. HAND. 2019. DOI: 10.1177/1558944719842238

[50] Initial Debridement of Dorsal Hand Abscesses in the Operating Room Does Not Improve Outcomes. HAND. 2019. DOI: 10.1177/1558944719836234

[67] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Felon.

[76] An Acute Nocardia Infection in a Pediatric Hand. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.03.039

[91] The incidence and severity of diabetic hand infection presentations during the COVID-19 pandemic. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231196026

[93] Contrast Enhanced Computed Tomography in the Diagnosis of Acute Pyogenic Flexor Tenosynovitis. HAND. 2022. DOI: 10.1177/15589447221092058

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.