Hand infections can be serious problems in children because they are varied, often difficult to assess, and sometimes cause long-term disability.
Penetrating injuries may cause infections of the soft tissues, bone, or joints of the hand. The organism is usually staphylococcus aureus.
Evaluate the injury by considering the animal, nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Give rabies prophylaxis for bites from carnivorous wild animals, bats, and unvaccinated domestic animals. Update the child’s tetanus immunizations. Administer a broad-spectrum antibiotic early. Leave deep contaminated wounds open and close secondarily.
Paronychia is a localized infection of the nail base. Manage with soaks and antibiotics, or drain if suppuration has occurred.
Subungual infection is a more extensive infection that often requires elevation and excision of the involved portion of the nail.
Fingertip infections may be difficult to differentiate from injury. Make this differentiation by the history, examination, systemic manifestations, and laboratory studies. Operative drainage is necessary if suppuration has occurred.
Herpetic Hand Infections
Most herpetic hand infections occur in infants and young children who have oral lesions. Establish the diagnosis by clinical features, viral cultures, or Tzanck smears. Resolution occurs in 3–4 weeks. Antibiotic treatment is indicated only for superinfections. Cover the lesions to prevent spread.
Inflammations or infections of tendon sheaths are not rare in children, and evaluation is more difficult due to the lack of cooperation during examination. The pattern of bursa and tendon sheaths of the hand are the same in children and adults. Ultrasound imaging may be useful in establishing the level and extent of inflammation and purulence. Manage most cases first with elevation, splinting, and antibiotics for 24 hours, then reassess. If not substantially improved, consider operative drainage.
The causes of dactylitis are numerous and include tuberculosis, sickle cell disease, congenital syphilis, psoriatic arthritis, and juvenile spondyloarthropathies. Most finger infections are due to osteomyelitis or septic arthritis.
Hand Abscesses and Otopharyngeal Infections
Abscesses of the hand may be associated with inner ear or pharyngeal infections.