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Orthopaedics · Hand infections: felon
Sample itemA gardener has a throbbing, very tense swelling of the index fingertip pulp after a thorn prick. What is the main reason this infection can lead to osteomyelitis of the distal phalanx?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Fibrous septa divide the pulp into closed compartments, so pressure rises and compromises the phalanx blood supply
A felon is an infection of the distal pulp space, which is divided by fibrous septa into tight compartments. Rising pressure causes ischaemia and can lead to osteomyelitis or necrosis of the distal phalanx. Early incision and drainage through a lateral longitudinal incision is the treatment.
Option by option
A. The nail bed communicates with the medullary canal
The nail bed does not communicate with the medullary canal.
B. Fibrous septa divide the pulp into closed compartments, so pressure rises and compromises the phalanx blood supply (correct)
Correct. Pressure inside closed septate compartments threatens the bone and soft tissue.
C. The flexor sheath ends at the pulp
The flexor sheath does not end at the pulp, and this is not the reason for complications.
D. The pulp has no blood supply
The pulp has a rich vascular supply, which is why infection is so painful.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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