Finger Infections - Paronychia- disruption of nail fold/ plate, mixed flora + staph - erythema swelling tender, can extend into eponychium - tx- warm soaks, po abx, I&D - Felon- infection of hyponychium, progressing to pulp - tx- soaks, elevation, abx; surgical- incision options for i&d - may use transverse incision here, must disrupt all septae, - wick/drain that is changed at 24hrs, - abx- iv in ed - Flexor Tenosynovitis- infx of synovial sheath around flexor tendon, - mechanism is penetrating injury, may be direct spread from other area; - s. aureus; - kanaval signs - flexed posturing, pain with passive extension, fusiform swelling of digit; TTP over palmar aspect of digit - tx- early- admit, obs, abx but will usually go to OR Nail Bed Injuries - get an xray, 50%with tuft fracture - repair: removal of plate, elevate proximal nail fold if needed; wash out; closure 5-0 chromic, 4-0 nylon for surrounding skin - protection of repair- native nail is ideal, or silicone, aluminum; secure with suture; protect scaring of nail fold down Tip Amuptations - Preserve fxnal length, durable coverage - <1cm squared can be healed by 2ndary intention; 4-5 weeks to heal, pain control, abx, tetanus; - Find digital nerves, pull out, trim to avoid neuromas. - Exposed bone- need rongeurs, bone cutters, take joint surface off - If you close primarily, space out sutures - Dressings non-circumferntial, loose2x2, cast padding, bias Finger Dislocations - palmar dislocation - recreated deformity then volar force - no splint needed, buddy tape - volar dislocations - hyperflex, dorsally reduce, splint in extension
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