Panaritium is an inflammatory process that is most often localized at the nail plate on the fingers. A problem arises due to accidental or systematic injury to soft tissues, as a result of which pathogenic bacteria and viruses enter the wound. They provoke severe swelling and the formation of purulent masses. In the absence of proper treatment or due to the transition of the pathology to an advanced stage, bacteria can affect not only the soft tissues of the fingers, but also tendons, bones and joints and lead to necrotic processes.

The disease can be recognized by a number of characteristic signs, including:

• significant sensations appear in the area of ​​the future source of inflammation, while the pain is characterized by strong pulsation;
• gradually the skin on and around the affected area becomes red, swelling and swelling may occur;
• pus begins to accumulate under the skin, which can sometimes begin to come out;
• the finger becomes virtually motionless, since every movement brings severe pain;
• the patient's temperature rises to +37.5 degrees, weakness and nausea may occur.

Attention! Sometimes the disease can cause not only low-grade body temperature, but also increase the readings to a critical +40 degrees. In this condition, it is important to immediately consult a doctor, since seemingly simple suppuration can cause more dangerous complications.

Antibiotics for panaritium of the finger

Ampicillin

In most cases, patients tolerate penicillin treatment well, and these medications show the best results in the fight against bacterial panaritium. Adult patients receive 250-500 mg of the active substance during therapy. The number of daily doses is selected individually and can be 2-4 times. The duration of therapy using Ampicillin is one to two weeks.

Erythromycin

A good antimicrobial drug that is used to eliminate most bacterial infections and inflammations. The drug rarely causes serious side effects and overdose when prescribed correctly. The amount of the main substance is 0.25-0.5 g of the drug. In the first days of therapy and in severe cases of panaritium, the patient can take up to five doses of the active component. To get a better and more lasting result, you should take the tablets one hour before meals or an hour after them. The duration of treatment with Erythromycin for felon is seven days, sometimes therapy is continued for two weeks. The daily dose of the active substance should not exceed four grams.

Ilozon

A good antibiotic, which belongs to more modern drugs than Erythromycin and Ampicillin. To get quick results, adult patients need to take 250-500 mg of the active substance up to four times a day. The maximum permissible daily dose of Ilozon is 2 g. Before starting treatment, you should check your kidneys, as taking the medication may negatively affect their function.

Attention! Drugs in this group are prescribed only for confirmed microbial pathogens such as felon, which may be related to streptococci and other pathogenic bacteria.

Anti-panaritium ointments on hands

Ichthyol

A safe ointment that does not cause tissue necrosis and can draw out the densest and deepest purulent tumors. Apply the medication up to three times a day in a thick layer. To get quick results, apply a bandage to the affected area. Ichthyol penetrates deep into the skin tissue, relieves swelling and inflammation. After the first use, the patient will notice noticeable improvements in his condition. The duration of therapy using Ichthyol is up to 14 days.

Vishnevsky ointment

It has a specific smell, but in the first few days it can relieve unpleasant symptoms. For treatment, it is necessary to apply a thick layer of ointment to the affected area and apply a compress. It is best to do this before going to bed. In the morning, the bandage must be removed, the wound must be disinfected with an antiseptic solution and the procedure must be repeated again. You can be treated in this way until the panaritium on your finger completely disappears.

Levomekol

The ointment is easy to use and provides quick results. Apply the medicine to a sterile gauze bandage, which must be applied to the sore spot and tied tightly. Change the compress only once a day so as not to cause an overdose. The duration of therapy using Levomekol is determined individually; treatment usually requires no more than two weeks. The ointment is an antibiotic, so you should first familiarize yourself with the contraindications to its use.

Syntomycin ointment

This medication allows you to accelerate wound healing, prevent the development of necrotic processes or eliminate their manifestation. For treatment, it is necessary to take only a sterile bandage or patch, onto which a small amount of medication is applied, a small pea is enough. Before applying, the felon lesion is treated with an antiseptic, after which a bandage is applied to the sore spot and fixed. Change the bandage once a day. The duration of therapy is up to two weeks.

Attention! When using ointments, it is important to change the dressings in a timely manner, since a large number of pathogens also accumulate under them, which ultimately can only worsen the patient’s condition.

Lotions against felon

Biosept

The medicine is available in the form of a solution for disinfection and lotions. For treatment, you need to take a clean cloth and moisten it with Biosept. After this, the compress is applied to the wound until it dries completely. You can repeat such manipulations up to six times a day. It is necessary to use such lotions only in combination therapy against felon. The duration of therapy is until the unpleasant symptoms disappear completely.

Video - Panaritium: causes, diagnosis, complications, prevention

Antisept

It is also a good antiseptic that helps prevent bacteria and viruses from entering the wound and the affected area. To use, you need to take a sterile bandage and moisten it with Antisept. After this, the lotion is applied to the sore spot for 10-15 minutes. Like Biosept, this disinfectant can be used up to six times a day until the manifestations of felon are completely eliminated.

Attention! Lotions should be included in combination therapy, since they cannot provide the necessary therapeutic effect to completely eliminate the disease.

Cost of medicines

The table shows all the drugs described for the treatment of panaritium of the finger with their cost.

Attention! These prices are indicative only and may not coincide with those indicated in your pharmacy network.

Traditional methods of therapy for the treatment of panaritium

Potassium permanganate solution

This procedure significantly disinfects the source of the disease and allows you to immediately apply ointments when using combined treatment. When panaritium is used, potassium permanganate must be used in the form of baths. To do this, you need to dissolve a little active substance in two liters of boiled water, its temperature should be +37 degrees. There is no exact dosage for such cases; you should focus on the color of the solution. It should turn purple. It is very important to ensure that all crystals are completely dissolved, as they can burn the skin. After this, the hand is lowered into the water and held there for about five minutes. You can repeat this procedure up to three times a day until the symptoms of the disease completely disappear.

Garlic baths

To prepare the medicine, you need to take a medium head of garlic and turn it into a paste. The resulting mass is poured with boiling water, the water temperature should be 80 degrees. After infusing the product under the lid for 10 minutes, you need to put your hand into it. This bath is carried out until the liquid cools completely. As soon as the procedure is over, you need to take out the entire pulp and apply it to the affected area. The sore spot is bandaged with a tight bandage and left until the morning. The procedure is repeated once a day until the symptoms disappear completely.

Video - How to treat panaritium on a finger

Soda baths

This method is perfect for treating pregnant women and children. For 500 ml of boiled water at room temperature, take a tablespoon of soda and salt. After thoroughly mixing the components, you need to dip the sore finger into the solution. The duration of the procedure is 15 minutes, after which the finger must be wiped with a paper towel and treated with ointment or antiseptic. This procedure can be repeated up to three times a day during the entire course of treatment.

Attention! With the bacterial type of panaritium, one cannot limit oneself solely to folk remedies, since it is important to completely eliminate the pathogen.

Prevention of panaritium on fingers

To prevent the disease, it is enough to adhere to the following rules:

Attention! Young children most often encounter the described pathology. To reduce the risk of panaritium, you should constantly use antibacterial wipes and gels, especially after visiting playgrounds and sandboxes.

If the above treatment methods fail to have the desired effect, a decision will be made to surgically remove the panaritium. Surgical intervention is also carried out in situations where the patient already has visible traces of necrotic processes or joints and bones are affected.

At the first signs of panaritium, treatment should be started immediately to avoid complications. If bone and joint tissues are injured, treatment will be lengthy, and the disease itself can become chronic and often make itself felt at the slightest decrease in immunity. Before starting a course of therapy, it is advisable to consult a dermatologist to confirm the diagnosis and prescribe adequate therapy.

If your finger is inflamed, there is severe pain that does not allow you to sleep, then most likely it is felon. Treatment of felon at home is often more effective than official treatment, but only in the first stages of the disease.

Here are examples of how it was possible to cure felon, taken from the newspaper “Vestnik ZOZH”

Causes and types of panaritium - from a conversation with doctor V. Khoroshev

What is panaritium

Panaritium is an acute inflammation of the tissues of the finger. Inflammation of the finger occurs due to minor damage to the skin.

The most common occurrence of panaritium is in people performing physical work that leads to microtrauma to the hands, with contamination of the hands with irritating substances. These are drivers, car service workers, builders, carpenters, mechanics, weavers, and cooks. It is especially dangerous if a person has endocrine diseases, works in conditions of high humidity and cold - these people have impaired blood circulation through the capillaries.

Types of panaritiums:

– cutaneous
– subcutaneous
– periungual
– subungual
– bone
– articular
– tendon
– complete – when all tissues of the finger are affected.

Causes of panaritium:

First of all, the cause is a violation of the immune system, i.e. a failure of general immunity and local (tissue) immunity. Therefore, in some people, inflammation of the finger occurs from the slightest injury, while others do not even know what felon is.

Scheme of disease development

The causative agent of the disease is most often white or aureus staphylococcus, less often E. coli and other microorganisms. Usually they are located on the skin, but as soon as a wound appears, they rush there, causing inflammation of the finger. The initial stage of the inflammatory process during panaritium is quickly replaced by purulent-necrotic inflammation, since the accumulation of exudate in a confined space leads to impaired circulation, and therefore to ischemic tissue necrosis and purulent melting.

Treatment of panaritium at home

If the finger is inflamed and the pain does not allow the patient to sleep, you should immediately run to the surgeon, but if medical help is not available, use the following means:
– ichthyol ointment or Vishnevsky ointment
– hot bath with potassium permanganate
– finger bandages with vodka, alcohol, cologne
– salt a piece of black bread and chew it. Cover the sore finger with this chewed bread and bandage it. (Healthy lifestyle recipes 2003, no. 21, p. 14)

How to treat felon with bread

Before washing the floors, the woman picked off a hangnail and brought the dirt under her nail. By nightfall, the finger became inflamed, swollen, red, and there was severe pain. This went on for several days, and finally she went to the doctor. The surgeon said that we need to remove the nail and clean the bone. But it didn’t come to that, because the patient was advised a folk remedy for felon. Take a piece of black bread, add salt and chew until it forms a paste. Place a piece of bandage on the parchment, then the pulp, then cover the top with the other end of the bandage. Apply all this to the sore finger and bandage it. By morning the swelling had subsided, and there was pus and blood on the bandage - the wound was completely cleansed. (HLS 2002, No. 17, p. 20).

If a finger breaks under a nail, one healer does this: she makes the patient dip his finger 3-4 times in very hot water, then chew black bread and onions, and covers the sore spot with this paste and bandages it with a bandage. The wound clears up overnight. Then he washes the wound with pink manganese water and makes another dressing. And everything heals. (p. 18, 2001, No. 15).

Treating felon at home with garlic

Beginning panaritium can be cured with garlic. You need to attach a clove of garlic to your finger and secure it (HLS 2013, No. 5, p. 33)

Treatment of finger inflammation with chalk

The following folk remedy helps a woman cure felon: she lubricates the skin with camphor oil and sprinkles it with crushed chalk, tying it with woolen cloth. After three days it gets better. The pain goes away, the pus flows out (HLS 2008, No. 14, p. 30)

How to treat aloe finger felon

The man developed a panaritium on his finger, spent a day in the hospital, had surgery on the third day, and the scar still remains. After some time there was a relapse. The finger became inflamed, festered, and a throbbing pain appeared. Then the man took an aloe leaf, cut it lengthwise and bandaged it with the pulp to the abscess, changed the bandage before going to bed, and the pain did not bother me at night. Aloe was changed every 12 hours. On the third day, the skin on the finger was white and wrinkled, dead. He cut off this skin and smeared the wound with Vishnevsky ointment. After a few days, only a trace in the form of a dot remained. Then this folk remedy helped him several more times. (Healthy lifestyle recipes 2008, No. 18, pp. 31-32).

A woman pricked her finger with a fish fin. After some time, an abscess formed. Neither ointment nor pills helped. My finger hurt so much that I couldn’t sleep at night until I saw an aloe plant on the windowsill. The patient cut off the leaf and applied it to the felon and bandaged it. An hour later the pain subsided and I managed to fall asleep. In the morning there was almost no pain, and the abscess had decreased. I repeated the procedure, and two days later there was no trace left of the wound. (2007, no. 23, p. 32).

Treatment of felon with plantain

The woman's nail on her little finger became inflamed. Three times they opened an abscess on one side of the nail, and the next day it appeared on the other side. The hospital offered to remove the nail, but the woman refused. A friend recommended a folk remedy for panaritium: pick plantain, wash it and tie it to your finger for a day. For the first time in a long time, the patient fell asleep peacefully, and after 3 days the wounds healed. It was possible to cure felon without surgery. (HLS 2011, No. 6, p. 39)

The woman developed an abscess on the second phalanx of her finger and her finger was swollen. At the hospital they cleaned her bone, but not very successfully. Repeated surgery was required. But the patient decided to treat the bone panaritium at home using the Nosal method - repeatedly wrapping the finger with plantain. The patient picked plantain leaves, washed them well, dried them, tied them to the incision, after steaming the wound in salt water. Now this cut is not visible. (Healthy lifestyle recipes 2010, no. 17, p. 33)

Onion and soap ointment for treating felon at home

One day a woman’s finger hurt, itched terribly, and an abscess appeared on the nail. I contacted a surgeon, he diagnosed felon, applied ointment to the abscess and sent me home. The abscess grew larger, the doctor removed the entire nail and applied the ointment again. Then remove the rest of the nail.

The patient went to visit her sister over the weekend. There, a neighbor gave her a recipe for ointment for panaritium and various boils. Take equal parts laundry soap, onion, rosin, beeswax, butter, grate everything and cook, stirring until smooth. After cooling, apply the ointment to a bandage and apply to the sore finger. After the first time, the wound was completely cleared. And the third time I applied the ointment for prevention. After the compress, I covered the wound with streptocide. Everything dried up, healing began, but the nail grew crooked for life. (HLS 2011, No. 2, p. 30)

Clay compresses

If the panaritium of the finger does not heal for a long time, clay compresses will help: you need to mix clay with urine until creamy, apply it to a gauze napkin and apply it to the felon on the finger. The same compresses will help if you have a growing bunion near your big toe. (2010, no. 16, p. 10)

Needle injections

Inflammation of the finger near the nail is a very unpleasant disease, it tugs and prevents you from sleeping. This remedy will help: with the tip of a thin needle from a sterile syringe before going to bed, pressing lightly, prick the entire area of ​​redness with crosses. There will be no inflammation in the morning. (HLS 2006, No. 2, p. 31)

Treatment of felon at home with celandine

The woman's big toe on her right foot began to itch near the nail. Then a panaritium appeared on the left toe. The pain was so severe that it was impossible to walk.
And since she had diabetes, these abscesses worried her very much. She brewed a strong infusion of celandine (1 tablespoon of herb per 1 glass of boiling water, boil for 10 minutes, leave for 2 hours). She soaked cotton wool in the infusion, applied it to the panaritium on her toe, a film and a bandage on top, and did the same with the second leg. Already in the morning I felt relief. The treatment lasted a week. Every morning and evening the patient changed the bandage and lubricated her fingers with nourishing cream with chamomile. Soon everything healed, the redness went away. (HLS 2006, No. 13, p. 8, 2003, 323, p. 25)

Celandine juice will help even better. You need to moisten a cotton wool in the juice and wrap it around your finger, with a fingertip on top. Change the cotton wool several times a day. The inflammation of the finger will go away very quickly. (Healthy lifestyle recipes 2004, no. 9, p. 22)

Iodinol treatment

The woman got a splinter on her finger, took the splinter out, but the finger did not heal for a long time. There is redness around the nail. A week later, the woman woke up from severe pain in her finger; it was very swollen, turned white, and filled with pus from the inside. She took iodinol, soaked a bandage in 3 layers, tied it to the abscess, and wrapped a towel on top. In the morning, the bandage was dry, the pus had resolved, but did not come out, and the finger was still swollen. After another three days of such compresses, the swelling went away. (2006, no. 23, p. 2)

Bone panaritium - treatment with a golden mustache

The woman was cleaning perches and pricked her index finger under the nail with a fin. Soon the pain subsided, but three days later a sore appeared on the finger, resembling a black and blue ball. The surgeon removed the nail, but it did not improve. A few days later, the entire finger swelled up, turned black, and stopped moving. Diagnosis: “felon of the finger bone.”

Neither antibiotics, nor ointments, nor procedures, nor baths prescribed by the doctor helped. It was then that an article about the healing power of the golden mustache plant caught her eye. She made a tincture: she grinded the whole plant in a meat grinder, poured in 500 ml of vodka, and left it for 10 days, instead of the prescribed 21 days, because there was no time to wait.

I started making compresses with this tincture at night, kept my finger warm during the day and lubricated it with this tincture several times a day. I also took 1 tsp of the tincture orally. In the morning on an empty stomach, adding a few drops of aloe juice, I also lubricated my finger with a strong infusion of St. John's wort. Treatment of panaritium lasted 20 days. The finger became as before, the nail grew clean and even. But she suffered for 8 months. (HLS 2006, No. 16, p. 30)

Recipe from panaritium

One day, a friend told a woman a recipe for panaritium, which helped her save her leg. The fingers were about to be amputated, but this folk remedy helped in 2 days. The recipe was dictated by:
Keep the limb in a pale pink solution of potassium permanganate for 30 minutes
Keep calendula tincture in the solution for 30 minutes - 100 ml per 1 liter of water.
30 minutes – in a solution of eucalyptus tincture – 100 ml per 1 liter of water.
In the same eucalyptus solution, moisten a bandage folded in 8 layers, squeeze it out, wrap it around the sore spot, and secure it with a bandage. Do not use film or compress paper here.

This recipe was useful to a woman three years later in a more serious case than panaritium. Her husband’s fingers were crushed by a weight so that all the muscles and skin burst, and dirt and fingerprints immediately got there. He was able to get to the hospital only after 2 hours. The surgeon immediately said that it was 99% amputation, and he bandaged it. The woman immediately remembered the recipe for felon and suggested that her husband be treated with folk remedies, but he refused. The next morning all the bandages were soaked in blood and pus. When they made a new dressing, these bandages were removed without soaking and pain relief, he almost lost consciousness from the pain. Then he agreed to be treated according to his wife’s method.

He held his hand in the first solution without removing the bandages; in 30 minutes they soaked well and came off. That night there was no more pain or twitching. The next day, the bandages came off well - there was no pus, and the wounds were clean with new skin. After the 4th procedure, the hand was no longer bandaged. After some time, the man met his surgeon, he asked why he didn’t go for dressings, and when he saw his hand, he was simply amazed. (Healthy lifestyle recipes 2006, No. 18, p. 9)

Treatment of inert panaritium at home with baked onions

After an injury, a woman’s finger became inflamed, then bone felon began. My whole arm turned red and an abscess the size of an orange grew under my armpit. She was told a folk remedy - treating felon with an onion. I baked an onion, put it on my finger and wrapped it with a towel on top. The pain quickly subsided, the woman slept for more than a day. But she woke up healthy, the bulb pulled out all the dirt and pus, even from under her armpit. (2004, no. 22, p. 17)

If your finger is inflamed, herbs will help

An ointment made from these herbs will help get rid of any pustular diseases - fistulas, boils, abscesses, ulcers. To prepare this ointment for inflammation and ulcers, you first need to prepare calendula oil. To do this, place 1.5 cups of calendula flowers in a stainless steel pan and pour a glass of vegetable oil at a temperature of 80-100 degrees, stir. When it cools down, transfer to a glass jar and leave in the dark for 40 days, strain.

Preparation of ointment. Fresh calendula flowers - 2 parts, yarrow - 2 parts, sweet clover - 1 part, dandelion roots - 2 parts, horse sorrel roots - 1 part, tansy inflorescences - 1 part. Wash all these herbs and pass through a meat grinder. Add 1 part of Vishnevsky ointment and 1 part of ichthyol ointment to the herbal gruel. Dilute this entire mixture with calendula oil prepared in advance to obtain a homogeneous elastic mass. Store the resulting ointment against abscesses in the refrigerator.

Panaritium should be treated as follows: Steam your finger in salty hot water, wipe it with cotton wool and alcohol and apply this ointment overnight. In the morning, repeat everything, change the bandages 2 times a day.

A woman used this ointment to treat a bitch's udder: she applied a napkin with ointment for the whole night, and changed it in the morning. By the evening, all the nodes had enlarged, the heads of abscesses appeared, and on the 3rd day all the pus began to come out. (Healthy lifestyle recipes 2006, No. 18, p. 31)

Treatment of inflammation of the finger with smoke

This very simple folk remedy helped cure felon and avoid surgery for many people; previously, on the battlefields, even gangrene was treated with this remedy. You need to take a fabric made of natural cotton, flannel, flannel, roll it into a flagellum and set it on fire at one end so that smoke comes out, fumigate the inflamed finger with this smoke for 1-3 minutes. If after some time the pain in the finger resumes, fumigate again. 2-4 procedures are enough, but it is better to treat felon with this remedy in the open air to protect the apartment from the smell. (HLS 2006, No. 25, p. 8,)

Treatment of felon with furatsilin

Crush the furatsilin tablet into powder, pour it onto wet cotton wool, wrap the cotton wool around the sore finger, and put polyethylene and a bandage on top. Leave it like this all night. If it doesn’t help the first time, repeat the procedure the next night. (HLS 2004, No. 5, p. 26)

If your finger is inflamed, baking soda will help.

The woman was helped to cure felon with a soda solution. 1 tbsp. l. Soda should be brewed with 1 cup of boiling water, stir. When it cools down to a warm state, put your finger in there. Do this procedure several times. (2004, no. 12, p. 7)

How to treat felon of a finger with solid oil

A woman pricked her finger with a wire. Dirt got in and my finger became inflamed. I didn’t go to the hospital, but applied technical grease. After 2 hours the pain subsided, and by evening the abscess opened. I applied solid oil again, and all the pus was drawn out overnight. In the morning I washed the wound with potassium permanganate and applied a Kalanchoe leaf. Everything has healed. In the village where the author of the letter lives, many residents use this remedy for panaritium and abscesses. (2005, no. 3, p. 8,)

Treatment with potatoes at home

To cure purulent inflammation of the finger, you need to grate a raw potato and apply the pulp to the wound. Secure with bactericidal plaster. Healing occurs very quickly. The recipe has been tested on many people. (Healthy lifestyle recipes 2005, No. 14, p. 29)

Hot water

The woman's finger became inflamed under the nail and an abscess appeared. The doctor said that it was necessary to cut it. But the woman decided to treat panaritium using the folk method. I made a hot soapy solution, the hotter, the more effective. I dipped my finger into the solution, counted to three, but couldn’t stand it until three, only 2 seconds. I drank until my heart began to protest. And in the morning the finger turned out to be healthy. There was no need to cut. (HLS 2005, No. 18, p. 10)

Using hot water you can also prevent the development of felon. As soon as a splinter gets under your nail, you need to pour hot water into a mug, add salt to it, and dip your finger in it. Then cut the nail short, clean and disinfect with alcohol or cologne - the finger will not become inflamed. (2003, No. 4 p. 4)

Ointment for all occasions

Take pine resin, medical tar, butter, aloe leaf pulp, and flower honey in equal proportions. Place this mixture in a water bath and heat there, stirring, until the mixture becomes homogeneous. If it turns out very thick, dilute with vodka.
This ointment helps with any non-healing fistulas, bone tuberculosis, abscesses, helps cure furunculosis, subcutaneous and bone panaritium. You need to smear the sore finger, cover it with plastic and wrap it with a bandage. (HLS 2003, No. 3, p. 25)

Treatment of felon at home with eucalyptus

If you have a purulent inflammation of your finger, then you need to finely chop eucalyptus leaves, cover your finger with them and secure with a bandage. (2003, no. 7, p. 13)

How to cure panaritium on legs with iodine

A 13-year-old girl constantly suffered from felons on her big toes. The ingrown nail plates were constantly bleeding, and I had to walk not in shoes, but in rag slippers. She had plastic surgery on her nail beds twice, but it didn’t help. Regular iodine helped. 3 times a day she smeared the affected areas with iodine until they turned dark brown. She did this for only 4 days. The skin peeled off in places from the chemical burn, but since then the panaritiums have not appeared again. (HLS 2003, No. 3, p. 25)

Cabbage treatment

A woman pricked her finger with a needle while sewing. The finger became inflamed and began to break out. A cabbage leaf was tied to the sore finger, changing the bandage 2 times a day. On the 4th day the finger was healthy. (HLS 2002, No. 3, p. 18,)

Nail felon - treatment with soap and protein

The beginning of a nail panaritium can be cured at home with the following ointment: grate laundry soap and add it to the beaten egg white until a paste is obtained. The consistency should be viscous, plastic, but not liquid. Apply this paste to the inflamed finger, on the sore spot, including some healthy skin. It is advisable to let the paste dry and set in the air, then bandage it. Walk like this for a day or two. After removing the bandage, you will see that the sore has broken through and pus has come out of it. If necessary, apply the bandage with soap ointment again (Healthy Lifestyle Recipes 2002, No. 12, p. 17)

Injury to fingers or toes is a very common situation; every person periodically gets hit or gets cut by something. If you do not properly care for the resulting wound in a timely manner, the situation can get much worse, and everyone knows this. Thus, an infection can penetrate, severe inflammation can develop, which will pose a real threat and require surgical treatment, and not just treatment with an antiseptic solution. On the hands, one of the consequences of untreated skin trauma is panaritium.

Panaritium - what is it?

Panaritium is an inflammatory process that is localized on the fingers of a person’s upper extremities (in rare cases, on the legs), characterized as acute and always with the presence of purulent discharge. This situation arises due to the fact that due to damage to the integrity of the skin, microbes penetrate into the wound and begin to actively multiply. The most common place for the formation of this process is the extreme phalanges of the hand in the area near the nail plate on the first three fingers of the hand, where invisible microtraumas very often occur.

This problem occurs most often in children and people aged 20 to 50 years. According to statistics, a third of all cases of infection are the result of injuries sustained at work. The complexity of the disease lies in the fact that due to the structural features of the fingers, although the inflammation does not spread lengthwise, it easily penetrates deep into the tissue, which explains the rapid progression of the disease involving tendons, bones, joints and other elements.

Causes of panaritium

The main reason for the development of the inflammatory process with the addition of pus is the penetration of bacteria. In the case of felon, the source can be staphylococcus, streptococcus, enterococcus, as well as mixed pathogenic microflora. The entry points for infection are damage to the integrity of the skin of various kinds (scratches, splinters, pricks with needles or bones, abrasions, cracks, hangnails). Usually the damage is so minor that it goes unnoticed by humans.

It is also possible to identify a number of external factors that create favorable conditions for the development of the problem:

• hypothermia of tissues under constant conditions;
• excessive prolonged moisture;
• exposure to vibration;
• the influence of skin irritants;
• working in the mud.

As for factors of internal origin, a decrease in the level of immune defense, a lack of vitamins, problems with metabolic processes, and diseases of the endocrine system can have a beneficial effect on the appearance and development of felon.

Symptoms and signs of abscess on finger

Symptoms have their own characteristics depending on the specific type of problem, but a number of general manifestations can be identified. So, at the very beginning of the process, redness begins around the damaged area, slight swelling and possibly mild pain or a burning sensation. Gradually the situation worsens, which is accompanied by a significant increase in swelling and pain. The sensations take on the character of bursting, tugging and very intense, sometimes because of them a person cannot even rest normally at night. As part of the inflammation, a focus of pus is formed, which in skin forms is clearly visible to the naked eye. The development of panaritium may be accompanied by a general feeling of weakness, fever and headaches. The deeper the disease develops, the more pronounced the symptomatic manifestations become.

Types of panaritium on the hands and methods of treatment

The most superficial form of the disease is cutaneous panaritium. A detached area of ​​the epidermis filled with cloudy pus forms on the surface, and this filling is easily visible through the skin. Usually, after the detached area of ​​skin is excised and the purulent contents are released, the area heals quickly and recovers without complications. But there are also deeper and more complex forms of the disease, which we will consider in more detail.

Subcutaneous

One of the most common types of the problem under consideration. It usually occurs when small but deep wounds become infected (for example, a prick with a thorn or fish bone). Inflammation and swelling gradually grow, the pain becomes pronounced and throbbing, and the general condition worsens significantly. Only a surgeon knows how to open a panaritium, since to eliminate the problem it is simply necessary to undergo surgery under local anesthesia. The wound must be drained in order to wash the cavity with antiseptic solutions during dressings.

Subungual

This type of disease most often occurs as a result of injury (bruise) to the nail plate. Due to such damage, a hematoma appears, which can fester. If the accumulation of blood under the nail was eliminated in time, then no problems usually arise - the doctor simply drills the plate and the blood comes out, recovery occurs in a short time. But if the situation has reached the point of the formation of a purulent sac, then the doctor will have to remove the entire nail plate in order to get to the affected area, and it usually takes several months for a new nail to grow (and in most cases, it grows deformed).

Periungual

This type of inflammation is called paronychia and is localized in the area of ​​the periungual fold. Most often, the problem begins with an unsuccessful manicure or ignoring skin hangnails. The abscess may be partially located under the nail, but it is easily visible through the thin skin around it. Spontaneous opening of the abscess is possible, but you should not wait for it on purpose, since the problem may not be solved by itself, but will only worsen, turning into a chronic form. The fight against the problem is standard - surgical excision of the abscess is necessary.

Bone

Bone felon is a more complex problem, which in most cases is a complication of improper or absent therapy for more superficial forms, but can also be the result of an open fracture. In the first stages, the symptoms are very similar to subcutaneous panaritium, but its severity is many times stronger. The pain is extremely intense and constant. The affected phalanx increases significantly in size, the skin acquires a rich red tint. Finger movements are limited by painful sensations. The destroyed bone requires surgical intervention, and, based on the complexity of the problem, the doctor can remove either one affected phalanx or the entire finger (thanks to effective antibiotics, the worst scenario can usually be avoided).

Tendon or purulent tenosynovitis

Tenosynovitis is the rarest, but also the most complex form of the problem. The causes of this condition are usually punctures, incised wounds, vinegars, as well as uncured superficial forms of the purulent-inflammatory process. The danger of this type lies in the fact that the process immediately spreads to the entire area of ​​the tendon sheath of the finger, and when pus appears, the nutrition is completely blocked, which leads to necrotic processes. Tenosynovitis manifests itself with the following symptoms: the finger thickens, all joints are in a semi-bent state, active movements become impossible, and the body temperature rises significantly. The extent of surgical intervention depends entirely on the prevalence and complexity of a particular case.

What to do and how to treat felon at home?

The first question that should arise for a person with panaritium in any of its forms is which doctor to contact, since without proper treatment the disease threatens great difficulties and even removal of the finger. Only surgeons treat such issues, and even hospitalization is possible. The superficial form can be eliminated using conservative methods, but only in the very early stages; in other cases, surgical excision cannot be avoided. Traditional methods in the treatment of such a disease can be used, but only in two cases: at the earliest stages of the development of the problem and with the permission of the doctor as an addition to the main therapy.

How to cure felon with folk remedies

Traditional medicine offers several recipes that can help a patient with such an unpleasant problem as panaritium on the thumb and any other area:

• onion compress. To prepare it, chop a quarter of the onion on a grater and spread it in a centimeter layer on a cloth napkin. The resulting compress must be applied to the damaged finger and fixed for several hours. After removing the product, it is important to take a bath with soda and salt, and apply fresh onions again. This event is held twice a day;
• alcohol tincture of propolis also used as a compress ingredient. A gauze pad soaked in this liquid is applied to the finger until completely dry. The product can be left on for a whole day, after which it is important to take a break for one day;
• cabbage leaf soften it by lightly beating it with the handle of a knife, and then simply fix it on your finger for three hours. This procedure is carried out twice a day every day.

Baths will help with an abscess on the finger near the nail

Baths turn out to be useful for speeding up the opening of shallow panaritium, and they can be prepared according to different recipes. However, the issue must be approached very carefully, since too high a water temperature can play a cruel joke and only accelerate the spread of the purulent process.

The first simple recipe is a bath with salt and soda. Dissolve a tablespoon of both components in half a liter of water and dip the affected finger into the resulting mixture. The procedure is recommended to be carried out three times a day for 15 minutes. A garlic bath is prepared in the following way: pour a crushed head of garlic with hot water in the volume of one glass and leave for a quarter of an hour. Afterwards, you can dip your sore finger in the liquid for 15-30 minutes.

How to remove pus from under your finger with Dimexide solution

Dimexide is a solution that consists of a substance called dimethyl sulfoxide, due to which it has a local analgesic, disinfectant and anti-inflammatory effect. The peculiarity of the drug is that it easily penetrates the skin and can act directly on the site of panaritium. To treat a purulent accumulation, do not use a pure solution, but diluted with water in a ratio of 1 to 4, otherwise there is a risk of a chemical burn. It is necessary to fold the gauze into 8 layers and moisten it in the resulting liquid, then apply it as a compress to the affected area, covering it with polyethylene on top and wrapping it well. It is recommended to leave this compress for 40 minutes.

Medicines

In addition to surgical intervention, drug treatment, both local and systemic, is also used.

Antibiotic names

Only the attending physician can make a decision about starting antibiotic therapy, and this method is necessarily prescribed in the postoperative period to prevent relapse in a wound that has not yet healed. Depending on the situation, both injections of antibiotics and oral administration may be prescribed. Considering the possible causative agents of the disease in question, doctors may recommend the following drugs:

• Amoxiclav (semi-synthetic penicillin with a broad spectrum of action);
• Levofloxacin (broad-spectrum antibiotic);
• Ciprofloxacin (an antimicrobial drug for systemic use that can suppress the growth of bacteria);
• Ceftriaxone (a third-generation antibiotic also with a broad spectrum of action);
• Lincomycin (shows effectiveness against staphylococcal and streptococcal infections);
• Josamycin (belongs to the group of macrolides, used when other types of antibiotics are ineffective).

Effective ointments

Various ointments can be used for local application to the lesion (in the early stages they can completely prevent the active development of the problem):

• Ichthyol ointment. The composition should be applied to the affected area twice a day in a thick layer and bandaged well on top;
• Vishnevsky ointment(apply to the area of ​​suppuration as a compress at night);

- This is a purulent inflammation of the bone structures of the finger. May be primary (less commonly) or secondary. The primary pathology is manifested by intense jerking pain and significant hyperthermia in combination with hyperemia, swelling and limitation of movements that occur a few days after a finger injury or against the background of a distant purulent process. Secondary bone panaritium develops as a result of the spread of infection in other forms of the disease, accompanied by low-grade fever and ongoing suppuration. Diagnosed based on examination, radiography, and laboratory tests. Surgical treatment – ​​opening, curettage, bone resection. If there is significant bone destruction, amputation is indicated.

ICD-10

M86 Osteomyelitis

General information

Bone panaritium is a type of purulent inflammation of the tissues of the finger with bone damage (osteomyelitis). It is a fairly common pathology; according to various sources, it accounts for from 37 to 60% in the overall structure of purulent-inflammatory processes in the area of ​​the fingers. Primary osteomyelitis of the phalanx is detected in only 5-10% of patients; in the remaining patients, secondary inflammation of the bone is observed. In the vast majority of cases (about 80%), the nail phalanx is affected. The disease is more often found in production workers with an increased likelihood of injury and intensive contamination of hands with irritating substances - tractor drivers, mechanics, loaders, handymen, etc. The pathology can be diagnosed in all age groups, with a predominance of middle-aged patients.

Reasons

The direct cause of bone panaritium is pyogenic bacteria, usually staphylococci, less often their association with other microorganisms, Pseudomonas aeruginosa, Escherichia coli and coccal flora (enterococci, streptococci). The primary form develops with hematogenous introduction of infection from distant purulent foci and with paraosseous hematomas. The causes of the secondary purulent process are:

• Subcutaneous panaritium. It occurs in the predominant number of cases, which is associated with severe local intoxication, severe local circulatory disorders that occur when the tissue of the finger adjacent to the bone becomes inflamed. Most often affects the distal phalanx.
• Tendon and articular panaritium. Subcutaneous panaritium is less frequently detected in the anamnesis. Usually precedes purulent melting of the bones of the main and middle phalanges.
• Other forms of felon. In some cases, osteomyelitis of the distal phalanx is detected with paronychia, subungual or periungual panaritium, but such cases constitute a small proportion of the morbidity structure.

Due to the high probability of developing bone panaritium in the subcutaneous form of the disease, there are indications in the specialized literature that when suppuration of the tissue persists for two or more weeks, osteomyelitis should be considered as a natural result of inflammation of the soft tissues. Predisposing factors to purulent bone lesions for any etiology of the process are considered to be endocrine diseases, exhaustion, decreased immunity of various origins (with some diseases, chemical dependencies, taking hormonal drugs), metabolic disorders, trophic and microcirculatory disorders resulting from prolonged exposure to cold, vibration, moisture or irritants to the skin of the hands.

Pathogenesis

With hematogenous spread of infection, pyogenic microbes penetrate into the bone substance through the feeding vessels. The periosteum and medulla become inflamed, and sequesters form in the bone tissue. In secondary pathology, inflammation from the soft tissues spreads to the periosteum. The development of the purulent process is facilitated by pathological and physiological conditions, especially pronounced during inflammation of soft tissue structures in the area of ​​the distal phalanges, in particular, a small volume of tissue, which causes the formation of a powerful focus of local infection, and severe disturbances of local circulation in the area of ​​the periosteum.

A feature of osteomyelitis of the phalanges of the fingers is the tendency to large-scale destruction of the periosteum. In osteomyelitis of other localizations, the periosteum reacts to inflammation by forming a so-called “bone box”, which provides the possibility of subsequent restoration of bone structures even if they are significantly destroyed. With a purulent process in the area of ​​the phalanges, this does not happen; the periosteum quickly becomes necrotic, its regeneration becomes possible only after excision of the sequestrum. With significant melting of the remaining areas of the periosteum, it is not enough to restore and form full-fledged bone. This explains the low probability of cure and the need for amputations during a prolonged or extensive inflammatory process.

Classification

Taking into account the etiology, a distinction is made between primary (arising against the background of trauma or hematogenous) and secondary (contact with other types of disease) bone panaritium. Since osteomyelitis primarily affects the distal phalanges, a classification has been developed that allows one to reasonably determine treatment tactics for this type of pathology. There are three types of damage to bone structures:

• Regional or longitudinal sequestration. Bone destruction is local in nature, the periosteum is slightly melted, complete restoration of the bone is possible. In the presence of a marginal sequester, the mobility of the finger is preserved after recovery. With longitudinal sequestration, the distal joint of the finger is involved in the process, resulting in ankylosis.
• Sequestration with preservation of the base of the phalanx. The purulent process is localized above the base of the bone, the epiphysis is not changed. Independent blood supply to the epiphyseal and diaphyseal zones of the bone provides favorable conditions for its restoration with sufficient preservation of the periosteum. The decision to preserve or amputate a finger is made individually, taking into account the size of the sequestrum and the duration of the disease.
• Complete sequestration of the phalanx. The changed bone is surrounded on all sides by a cavity filled with pus. Suppuration spreads to the joint and tendon sheath. The periosteum is completely destroyed or small areas of it remain, incapable of full regeneration. Amputation required.

Symptoms of bone panaritium

With secondary damage, the distal phalanges of the 1st, 2nd and 3rd fingers are usually affected. Initially, a characteristic clinical picture of subcutaneous panaritium is observed, accompanied by local swelling, hyperemia, throbbing pain along the palmar surface of the finger, weakness, weakness, and increased temperature. Then a focus of suppuration forms in the affected area, which is independently opened onto the skin or drained by a purulent surgeon, local and general signs of inflammation decrease. The spread of pus to the bone structures is manifested by a repeated intensification of symptoms, which in the initial stages of osteomyelitis, however, does not reach the degree of severity characteristic of subcutaneous panaritium.

With primary damage, panaritium develops acutely. The phalanx swells, the skin turns red and then becomes purple-bluish, and intense jerking pain occurs. The finger is in a forced flexion position; active and passive movements cause increased pain. There is significant general hyperthermia, body temperature sometimes reaches 40˚C, and chills are possible. With the progression of the primary and secondary process, a flask-shaped expansion of the finger is revealed. The skin on the affected phalanx is tense, smooth, and shiny. The phalanx is painful throughout. Areas of necrosis form. Fistulas are formed, usually located in the subungual area. Deformations associated with the destruction of soft tissue and bone structures may occur.

Complications

In case of immunity disorders, improper or untimely treatment, bone panaritium can develop into pandactylitis - inflammation of all tissues of the finger, including joints and tendons. In some cases, the purulent process spreads in the proximal direction. Possible phlegmon of the hand, deep phlegmon of the forearm, purulent arthritis of the wrist joint. In severe cases, sepsis develops, which poses a threat to the patient's life. The outcome is often contractures, stiffness or ankylosis caused by gross scarring, damage to nearby tendons and joints, and prolonged immobilization.

Diagnostics

The diagnosis is made by specialists in the field of purulent surgery when the patient visits the clinic, less often - during emergency hospitalization due to severe symptoms of the purulent process. The diagnostic process takes into account the characteristic anamnesis, the typical clinical picture of the disease and data from additional studies. The survey plan includes the following activities:

• Questioning, inspection. In the primary process, a history of finger injury or the presence of a distant purulent focus is revealed. In the secondary version, it is established that the patient has suffered from another form of panaritium over the previous two or more weeks. Upon examination, swelling, redness and a fistula with purulent discharge are detected. With careful insertion of the probe, the eroded surface of the bone is determined.
• Radiography. The radiological sign of the disease is uneven clearing of the phalanx, caused by reactive osteoporosis, in combination with erased contours, and later - eroded contours and a focus of destruction. Sometimes, as inflammation progresses, the bone is almost invisible on the x-ray of the finger, which can be mistakenly regarded as necrosis. With necrosis, the shadow of the bone is preserved; a sequestrum is visible against its background, which can shift over time. When a joint is involved, the joint space narrows and the articulating surfaces of the bones become uneven.
• Laboratory tests. Purulent inflammation is accompanied by characteristic laboratory changes: an increase in ESR, leukocytosis with a shift to the left, the presence of rheumatoid factor, C-reactive protein and antistreptolysin-O in the blood. Culture of wound discharge indicates the presence of pyogenic microflora and allows one to determine its sensitivity to antibiotics.

Treatment of bone panaritium

Treatment is only surgical. The incision site is selected taking into account the location of the fistula and X-ray data, based on the principles of maximum preservation of the functions and working surface of the finger. Typically, the opening of the panaritium is carried out by expanding the fistula tract. Both bone sequestra and the affected surrounding tissue are subject to excision. Removal of non-viable areas has its own characteristics associated with the insignificant volume of tissue in this area. When excising the fiber, do not use a scalpel or ordinary scissors; the modified segments are grabbed by a mosquito, pulled towards themselves and carefully cut off section by section with pointed scissors.

Then they begin to remove the affected bone, which should also be extremely economical. Loose bone sequestra are excised. Separately located healthy areas that have maintained contact with the periosteum are left even with an uncertain prognosis for their recovery. The wound is washed with a tight stream of hypertonic solution from a syringe. Subsequently, dressings are carried out, general antibiotic therapy is supplemented by the introduction of antibiotics into the source of inflammation.

If there are no prospects for restoration of the phalanx, or there is a threat of further spread of infection, amputation or disarticulation of the finger is performed. When deciding to amputate the first finger, its functional significance is taken into account; if possible, they try to preserve every millimeter of length even with the threat of deformation and ankylosis, since a deformed or immobile finger is often more functional than its stump. If the remaining fingers are significantly affected, the amputation level is chosen to create a functional stump with a scar-free working surface.

Prognosis and prevention

The prognosis of bone panaritium is determined by the prevalence of the osteomyelitic process, the preservation of the periosteum and the degree of involvement of surrounding structures. With timely treatment of marginal sequestration, the outcome is usually favorable. In other cases, in the long term, shortening and/or impaired mobility of the finger and cicatricial deformities are possible. Prevention consists of preventing industrial and household injuries, using protective equipment (gloves) when working with irritating substances, timely contacting a surgeon in case of inflammation and injuries of the fingers, adequate opening and drainage of other forms of panaritium.

11947 0

- This is osteomyelitis of the phalanx. In the last decade, the number of complicated forms has been decreasing, but among them, bone panaritium remains in first place.

All arteries of the hand participate in the blood supply to the bones of the hand, forming a dense network with a mass of anastomoses not only in the soft tissues, but also in the skeleton. The distal phalanx has an additional arterial branch (Fig. 21), which provides the epiphysis of the phalanx with resistance to infections and the possibility of regeneration.

Depending on the structure of the phalanx, the virulence of the infection, the treatment performed and the patient’s health status, osteomyelitis affects either part of the phalanx (limited marginal osteomyelitis), or the entire diaphysis (diaphyseal osteomyelitis), or the process involves the entire phalanx (total osteomyelitis).

Bone panaritium as a hematogenous osteomyelitis and as a primary focus of inflammation is rarely observed (in 5-10%). In the majority of patients (90-95%), the process in the bone occurs secondary, as a complication of purulent inflammation in the soft tissues (E. V. Usoltseva, 1970).

Primary bone panaritium is recognized on the basis of increasing local signs of inflammation localized in the phalanx of the finger. This is an incessant pain that develops in the depths - in the bones; it forces you to keep your finger in a forced position, to protect your hand from movement and touch.


Rice. 22. Osteomyelitis of the diaphysis of the middle phalanx of the index finger in the sequestration phase (schematic drawing from an x-ray).
a - before surgery; 6 - after sequestrotomy; c - treatment outcome after 4 months.


This is tension in the soft tissues of the finger. Later, redness and swelling and general malaise appear, sometimes with an increase in body temperature.

When examining the phalanx with a button probe, sharp pain is detected on the dorsal and palmar sides.

Secondary bone felon is recognized on the basis of the complicated course of soft tissue felon. The clinical picture in most patients develops against the background of an operated subcutaneous panaritium of the distal phalanx. After several days of improvement in general condition, subsidence of pain and reduction of swelling, a delay in discharge occurs. Throbbing pain, swelling, redness appear; the tip of the finger swells like a flask, becomes hot, the joints of the fingers are rigid, movements are limited and painful, the general condition and well-being of the patient again worsens. This picture indicates that the felon has become more complicated and the infection is spreading deeper. It is necessary to find out where it is localized: in the bone, in the joint, in the tendon sheath, or whether the process has spread to all tissues of the finger.

These symptoms first of all allow us to suspect the presence of bone panaritium as the most common type of complication. Articular and tendon panaritium are excluded based on the nature and location of pain (when examined with a button probe), the extent of the tumor and dysfunction. X-ray examination in the first 7-10 days does not provide convincing data, since destructive changes in the bone are detected after 10-15 days and already serve as confirmation and clarification of clinical recognition.

In the X-ray picture of bone panaritium, three stages are distinguished. The first is manifested by spotty osteoporosis, the second by periosteal reaction, the third by bone destruction, sometimes with the formation of sequestration. In this case, the affected area of ​​the bone often maintains contact with viable tissues for a long time, sometimes resolves without sequestration or takes part in regeneration. Examination of the wound with a button probe can sometimes reveal the presence of exposed bone - this is not a reliable sign of osteomyelitis, especially on the distal phalanx.

Recognizing bone panaritium after 3-4 weeks, in the sequestration phase, is no longer difficult. The affected phalanx remains flask-shaped, swollen, there are fistulas with purulent discharge, and the X-ray shows bone destruction, sometimes the presence of sequesters. Bone panaritium of the middle and proximal phalanges and metacarpal bones has a more similar clinical and radiological picture to osteomyelitis of the long tubular bones.

Treatment of bone panaritium. Experience shows that the earlier a bone infection is recognized and the more distal the affected phalanx, the greater the chance of cure without additional surgery. Treatment of bone panaritium of the distal phalanx begins with examining the patient, determining the cause of the complicated course, assessing previous treatment and a plan for further measures.

Repeated operations on the hand are performed as planned under the guidance of the responsible surgeon and if appropriate conditions for intervention are available.

Before surgery for osteomyelitis, not only skin preparation is performed, but also antibiotic therapy, if it does not precede complications. Having determined the microflora and its sensitivity to antibiotics, it is possible to perform a regional intravenous or intraosseous infusion of antibiotics with their prolonged deposition in the lesion. A solid, unlined plaster cast also helps to isolate the process.

Our experience shows that in almost a third (30.4%) of patients, after thorough cleaning of the skin and wound and immobilization, there is no need for reoperation. The inflammatory process regresses - small sequesters recede, the wounds are cleaned and healed.

Paying tribute to complex conservative measures and antibiotics, using them in various ways, we still do not dwell on them. If there is no obvious improvement (reduction of pain, swelling, discharge), there is no restoration of joint mobility, the patient’s desire to use his arm, and X-rays reveal sequesters, there is no reason to delay the operation.

To assess the results of conservative therapy and to prepare the patient, an average of 5-7 days is enough. In 85 of the 125 patients we observed, the process in the bone did not resolve, and they were re-operated.

The operation is performed under conduction, intraosseous or intravenous anesthesia and bleeding, sometimes under general anesthesia.

The incision is made depending on the localization of the inflammatory process using fistulous tracts and previous surgical wounds. The soft tissues are cut down to the bone with a scalpel, pulled apart with hooks and examined. I In this case, various process options may occur:

1. An incision opened a purulent pocket in the soft tissues, revealing the exposed tuberosity of the distal phalanx. The surrounding tissues adhere tightly to the bone. In this case, necrotic soft tissue is excised. The wound is washed with furatsilin solution. The exposed area of ​​the tuberosity is covered with soft tissue. The edges of the wound are brought together with an aseptic adhesive bandage. Immobilization.

2. An incision opened a purulent focus in the soft tissues and revealed a naked, deformed, mobile area of ​​the tuberosity of the distal phalanx. Necrotic tissue and a section of sequestered bone are excised using sharp scissors or nippers from a manicure set. The wound is washed with furatsilin, a piece of hemostatic sponge is placed; the edges are brought together with an aseptic bandage; immobilization.

3. The granulating wound was expanded with an incision, and bone sequestra and an exposed, pitted tuberosity of the distal phalanx were found in it. Partial or complete resection of the tuberosity is performed. It is advisable to use a special hand retractor and cut down the bone with a diamond disk of a drill; the sawdust is cleaned with a milling cutter. To avoid deformation of the finger, on the 7-8th day, after preparing the wound, secondary sutures are applied and the tip of the finger is given the correct shape. On the thumb of people with a highly developed tuberosity of the distal phalanx after its resection, it is necessary to carefully monitor the formation of the scar, and sometimes recommend to the patient plastic replacement of the defect.

4. Marginal osteomyelitis of the phalanx diaphysis was detected. Necrotic soft tissues and fistulas are excised, the periosteum is sparingly peeled off, and the periosteum is shifted; The affected area of ​​bone is removed with an oval chisel or a sharp spoon. The edges of the bone wound are leveled, the bone is covered with periosteum, the wound is washed with an antiseptic, and its edges are brought together with an aseptic bandage. Immobilization.

5. A purulent focus is opened. In the depths, exposed from the periosteum, rough, mobile bone and several sequestra are visible. It is necessary to widen the wound, sometimes to make an additional incision, allowing one to examine the entire phalanx and remove the affected part, preserving the epiphysis, which has an additional artery, the distal interphalangeal joint and soft tissue. If pus penetrates into the joint (osseous-articular panaritium), an arthrotomy is performed, necrotizing tissue is removed, the cavity is washed with a solution of antibiotics or antiseptics, the outflow of the discharge is ensured, and the finger is immobilized.

These are the main options for pathological changes in bone panaritium of the distal phalanx.

Note that in 20-25% of the patients we observed, the operation was limited to eliminating deficiencies of the previous intervention. At the same time, pockets with retained pus, pieces of necrotic tissue, nails, rubber residues from drainage, bone “crumbs” and other bodies supporting suppuration were found in the wound. During the examination, traces of incomplete processing of the bone were revealed: the presence of potholes, cracks, detachment of the periosteum, etc.

The rapprochement of the wound edges is achieved with a secondary suture, an adhesive plaster bandage, an unlined plaster cast or a long-term non-burdensome bandage with Unna paste. Postoperative treatment of patients is carried out according to the principles already outlined.

S. A. Stupnikov (1974) provides the following results of treatment of osteomyelitis of the nail phalanges in miners. Of 1340 observations, complete restoration of function in the absence of deformation of the phalanx was observed in 718 patients, restoration of function with a defect of the phalanx was observed in 326 patients, with a defect of the finger in 153 patients, with a defect of the hand and limited function in 87 patients. Amputation of the nail phalanx was performed in 47 patients; finger - in 9 people. The average duration of treatment is 19.8 days.

Bone panaritium of the middle and proximal phalanx of the fingers is much less common, being a complication of subcutaneous or tendon panaritium; as a primary form it rarely occurs. Recognition of the bony panaritium of the middle and proximal phalanges and metacarpal bones is based on the same features as the distal phalanges. The clinical picture and functional disorders are more pronounced.

It is necessary to differentiate osteomyelitis from subcutaneous, tendon panaritium, phlegmon of the hand, from specific damage to the phalanges in tuberculosis, brucellosis, syphilis and from tumors. A carefully collected anamnesis, careful examination of the patient and x-ray examination allow you to avoid mistakes.

When treating bone panaritium of the middle, proximal phalanges and metacarpal bones, while there is no clear localization of the process in the bone, the entire arsenal of abortive treatment is used in combination with antibiotic therapy and immobilization.

Bone panaritium in the phase of purulent melting should be operated on. The operation is often atypical. An incision is made over the inflammatory focus through fistulas or previous surgical wounds. The soft tissues are cut in layers, sparing the digital nerves and tendon sheath. When the exposed periosteum has a normal color and is not exfoliated, it should not be cut or scraped. Bone trepanation is performed in cases where there is excoriation of the cortical layer, a fistula, or osteomyelitis with a sequestral cavity is determined by radiological examination. Then you need to open the bone marrow cavity with an ear cone-shaped or grooved chisel enough to allow inspection and treatment of the lesion. Then, with a sharp spoon, granulations and sequesters are removed, the wound is washed with furatsilin, the edges of the bone wound are carefully leveled, smoothed, the cavity is washed again and dried.



Rice. 23. Outcome of osteomyelitis in patient G.
a - deformation of the hand and third finger, limitation of function; b - diagram from the radiograph - deformation of the proximal phalanx of the third finger, synostosis of the II and III carpometacarpal joints.


Only after making sure that the treatment is complete, i.e., that there are no areas of necrosis, granulation, small bone fragments, notches and foreign bodies in the bone and soft tissues, does bleeding stop and hemostasis is ensured. The bone wound is covered with periosteum or aponeurosis, sometimes strengthened with one or two sutures, or a hemostatic sponge is placed. The skin is cleaned of traces of blood and tanned with alcohol. An aseptic bandage is applied to bring the edges of the wound closer together. The arm is placed in a pre-prepared plaster splint. If possible, drains and drains are not inserted into the wound.

In a complicated course that occurs due to delayed or insufficiently radical intervention, bone panaritium becomes a serious disease requiring hospital treatment.

Ancillary worker at a pig farm G., 53 years old; does not know the cause of the disease. He gets small wounds, cracks, and calluses on his hands very often. Ten days ago pain and swelling of the third finger of the left hand appeared. In the district clinic, the subcutaneous panaritium of the proximal phalanx was opened using a palmar-lateral incision. The wound is packed. The process was not resolved. For two weeks he was treated with UHF and penicillin injections. Repeated operation: two lateral incisions, scraping with a spoon, drainage of wounds.


Rice. 24. Disfigured tip of the first finger with an ingrown nail and numerous retracted, painful scars after osteomyelitis of the distal phalanx.


And this operation did not provide sufficient cleanliness of the bone and outflow of discharge; the process progressed and was complicated by dorsal subaponeurotic phlegmon, lymphangitis, and osteoarthritis of the carpometacarpal joint. Hospitalization.

Operation under anesthesia. Trepanation and sequestrectomy of the proximal phalanx, opening of the subgaleal phlegmon, immobilization. Long-term treatment with antibiotics. Symptoms of uncontrollable hand, polyfibrositis, joint stiffness, arthritis of the carpometacarpal joints. The outcome is group II disability combined with general diseases (Fig. 23).

Osteomyelitis, which occurs when infection spreads to the metacarpal bones from the surrounding soft tissues, is observed as a complication of unrecognized or improperly treated phlegmon of interfascial spaces and tenobursitis. This form of severe infection of the hand was studied and described by A. N. Ryzhikh and L. G. Fishman (1938) under the name “panphlegmon,” indicating that the inflammatory process involves all tissues of the hand. X-ray examination in these cases reveals osteoporosis of the hand skeleton, osteoperiosteal damage to one or more metacarpal bones, sometimes with the presence of marginal or central sequestra in them. The process is often accompanied by serous or purulent arthritis of the wrist joints.

Three quarters of the bony panaritium falls on the distal phalanx, and therefore the question of preserving the fingertip as an organ seriously arises.

The result of ill-conceived treatment of osteomyelitis of the distal phalanx is long-term disability and a malformed phalanx.

For example, patient P., 35 years old, with osteomyelitis of the distal phalanx, had a sick leave for 138 days, and then for about two years “mastered” the tip of the first finger of her right hand, deformed after four operations and numerous antibiotic infusions (Fig. 24).

A tenth of the bony panaritium is observed on the proximal phalanx, and the same amount occurs on the middle phalanx and on the metacarpal bones together. The largest percentage of bony felon occurs on the first toe (31.4%); slightly less (28.8%) - in the second; 20.3% - on the third; significantly less on the fingers of the ulnar group: the fourth - 9.5%, the fifth - 6.7%, and in 3.3% of medical histories the localization of the disease is not specified.

The vast majority of patients with bone panaritium (79.8%) were operated on, the rest were treated conservatively. The duration of treatment ranges from 10 to 44 days.

Complications of bone panaritium were noted in 7.8% of patients; their nature and frequency (in%) are given below:

Joint stiffness 16.6
Trophic disorders 10.1
Painful disfiguring scars 9.8
Complications of other types of purulent infection 19.5
Combined complications 39.4
Others 4.6

It follows that the vast majority experienced combined complications, for example, a combination of finger stiffness and scar pain. The consequence of insufficient opening of the lesion in every fifth patient is the complication of osteomyelitis with another type of purulent infection.

It is noted that often secondary complications (arthritis, phlegmon) did not appear immediately, but after exertion, after several days of work.

M.I. Lytkin and I.D. Kosachev at the XIV Plenum of the Board of the All-Union Society of Surgeons (1973) based on compiled statistics from domestic and foreign authors, covering 980 cases of bone panaritium, reported that during treatment, 23% of patients had amputation of a phalanx or finger . Having experience in treating more than 400 patients with bone panaritium at the Leningrad City Center for Hand Surgery, we have not performed a single amputation of a finger, but among the truncations of phalanges and fingers aimed at follow-up treatment, they account for 5.8%.

The functional outcomes of patients after bone panaritium are as follows: they retained their profession - 77.4%; retained their ability to work - 15.4%; stopped working for a combination of reasons and age - 4.8%; information is not accurate - for 2.4%.

E.V.Usoltseva, K.I.Mashkara
Surgery for diseases and injuries of the hand