Septic arthritis of the fingers

A patient's finger joints are easily infected from open wounds, or from nearby infections. A human bite into a joint is particularly dangerous. The infected joint is acutely tender, swollen and painful. Its ligaments, cartilage, and bone are soon involved, so that he inevitably ends up with a stiff joint. A stiff DIP joint is little disability, but if he has a stiff MP or PIP joint, his finger but not his thumb are probably better amputated.

SEPTIC ARTHRITIS [s7]OF THE FINGERS Give the patient an antibiotic (8.1); but this is less important than drainage and an efficient surgical toilet.

Open the joint immediately, especially if there is a wound over it. If the edges of the wound are not obviously infected, excise their extreme margins. Examine his extensor tendon.

If his extensor tendon has not been divided, enter the dorsolateral aspect of the joint and retract it to the opposite side. Look inside the joint. Remove any debris and loose bits of cartilage or bone. Syringe it out with saline. Leave his skin wound open for delayed primary closure. If you had to divide his extensor expansion, repair it at the same time. Immobilize his joint in the position of function (7.17), in case it stiffens, not the position of safety (75.2).

If his finger (but not his thumb) is stiff, consider amputation if he is an adult[md]but not if he is a child!