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[Hand infections in children]
1Service de traumatologie et orthopédie, hôpital Necker-Enfants-Malades, Paris, France.
Insights
Hand infections in children, like whitlow, often stem from foreign bodies or nail-biting. Prompt treatment with antisepsis and antibiotics is key, but severe cases like tendon sheath infections require immediate surgery.
Area of Science:
- Hand infections in pediatric patients
- Infectious disease of the hand
- Dermatology and Orthopedics
Context:
- Subcuticular whitlow is the most common hand infection in children, often caused by foreign body penetration (e.g., thorns) or onychophagy (nail-biting).
- Standard treatments include local antisepsis, Dakin's fluid, and antibiotics targeting Staphylococcus aureus.
- More severe infections, such as subcutaneous whitlow, paronychia tendinosa, fungal, or herpetic whitlows, necessitate distinct and often urgent interventions.
Purpose:
- To outline the common causes and effective treatments for various types of hand infections in children.
- To differentiate management strategies based on infection type and severity.
- To emphasize the critical nature of specific infections like paronychia tendinosa.
Summary:
- Subcuticular whitlow, frequent in children, is typically treated with antisepsis and antibiotics for Staphylococcus aureus.
- Extension to subcutaneous whitlow requires surgical intervention.
- Paronychia tendinosa, a severe flexor tendon sheath infection, demands emergency surgery and intravenous antibiotics.
- Fungal and herpetic whitlows require specific therapeutic approaches.
- Hand bites necessitate careful evaluation and surgical consultation.
Impact:
- Provides a concise guide for clinicians managing pediatric hand infections.
- Highlights the importance of early and accurate diagnosis for appropriate treatment selection.
- Reduces the risk of long-term sequelae associated with severe hand infections through timely intervention.
Abstract:
Subcuticular whitlow is the most frequent form of hand infections in children, mainly resulting from the penetration of a foreign body such as a thorn bush or onychophagy. Local antispesis, Dakin's fluid baths and eventually antibiotics directed toward Staphylococcus aureus are usually effective therapies. Extension to a subcutaneous whitflow needs surgery. Specific treatment must be used in case of fungal and herpetic whitlows. Paronychia tendinosa is a severe form of infection affecting flexor tendons sheaths with a high risk of sequelae; it requires an emergency surgical excision and i.v. anti-Staphylococcus aureus antibiotics therapy. Hand bites need particular attention and systematic surgical advice.