Pediatric hand infections

Abstract

Hand infections are an important cause of morbidity in the pediatric population. Such infections should be promptly evaluated including a history taking into consideration any traumatic exposure, the patient’s immunization status, the presence of comorbidities, and environmental exposures. Infections can be categorized into superficial spreading infections, closed space infections, and other infections. Infections involving the finger include paronychia, felons, and flexor tenosynovitis. Deep space infections can involve the thenar, hypothenar, midpalmar, and/or Parona’s space, as well as the interdigital subfascial space.Atypical infections of the hand often behave in a more indolent manner and are typically caused by nonbacterial organisms including viruses or mycobacterial species. A high index of suspicion is necessary to diagnose atypical hand infections, as the organisms often require special culture media in order to obtain an accurate diagnosis. Bite wounds from both animals and humans are common in the pediatric hand and require antibacterial coverage accounting for unique organisms such as Pasteurella and Eikenella. Septic arthritis and osteomyelitis are particularly worrisome hand infections that require aggressive treatment to eradicate.A careful history can often provide clues as to the underlying microbiology in pediatric hand infections. These infections must be closely monitored early on, and if any closed collection of purulence is found, surgical drainage is indicated. Postoperative care includes short periods of immobilization and elevation, followed by early mobilization, once resolution of the acute infection is achieved.