Articulate a felon – purulent damage of an interphalanx or pyastnofalangovy joint. Arises at injuries, progressing of other types of a felon, it is rare – at distribution of infectious process of the remote centers. It is shown by the acute pain reaching maximum efficiency at night, hypostasis, reddening, typical veterenoobrazny deformation of a finger, restriction of movements, symptoms of the general intoxication. It is diagnosed taking into account complaints, data of the anamnesis and objective survey, results of a X-ray analysis and laboratory analyses. Sometimes carry out a puncture of the affected joint. Treatment – opening, drainage, the general and local antibiotic treatment.
Articulate a felon – a kind of a deep felon. Along with bone and tendinous forms of a disease in the absence of treatment has the expressed tendency to distribution on the next structures with development of a pandaktilit, in the remote period it becomes frequent a cause of infringement of function of a brush. Usually results from traumatic damages of circumarticular fabrics, is a consequence of progressing of other types of a felon less often. Proximal and distalny interphalanx joints are surprised with an identical frequency, the pyastnofalangovy joint suffers less often. The disease can come to light at persons of any age and a floor, some prevalence of the young men and men of middle age more often injuring joints of fingers in fights or in the course of professional activity is noted.
Reasons of an articulate felon
Staphylococcus acts as the causative agent of a disease more often, in crops the monoculture or microbic associations can come to light. More rare infectious agents are colibacillus, a sinegnoyny stick, streptococci, enterokokk, other piogenny bacteria. Taking into account an etiologichesky factor distinguish three types of an articulate felon:
- Primary. Turns out to be consequence of a trauma of a zone of a joint, can develop at the stings, chipped, the cut or hurt wounds, mainly on the back of a finger that is connected with the insignificant volume of soft fabrics and smaller density of skin on a dorsalny surface. Especially often arises at blow by bones of fingers to the area of teeth during the fight.
- Secondary. It is formed at contact distribution of a purulent inflammation from the next structures. First place on prevalence is won by involvement of a joint at a bone felon, the second – at tendinous, the third – at hypodermic. Sometimes casual opening of a cavity of a joint at treatment of other types of a felon becomes a provocative factor.
- Metastatic. It is observed at hematogenic distribution of piogenny bacteria. Meets extremely seldom, in literature isolated cases are described.
The burdening factors at any etiology of a disease are violations of exchange, a disease of endocrine system, local frustration traffic and microcirculation at Reynaud's syndrome, long chemical, temperature or vibration influences. An essential role is played by immune violations at oncological diseases, insufficient food, alcoholism, drug addiction, reception of some hormonal medicines.
On a forward surface joints of fingers are strengthened by a thick palmarny plate (an additional palmar sheaf), on side – dense lateral sheaves. On a back surface the joint is covered by only thin skin and sinews of razgibatel. At damage of soft fabrics to a circumarticular zone infectious agents easily get into a joint also begin to breed that is followed by bystry formation of a clinical picture of sharp purulent process. Intensive pains appear from behind the insignificant volume of a joint at a congestion of purulent contents and hypostasis of surrounding fabrics, the finger adopts the compelled provision.
At distribution of other forms of a felon, especially – bone and tendinous, the disease masks inflammatory process in nearby fabrics therefore damage of a joint at an early stage can remain unnoticed. Distinctive features of this anatomic zone the small amount of hypodermic cellulose at prevalence of firm structures is considered. The necrosis prevalence over suppuration is a consequence of these features. Sluggish fusion and fragmentation of fabrics with their subsequent delayed rejection is observed.
Experts in the sphere of purulent surgery usually use phasic classification of an articulate felon. Systematization of process allows to determine by phases more precisely medical tactics, probability of development of complications and the forecast at different stages of a disease. Taking into account this classification distinguish three stages of inflammatory changes in a joint:
- Serous and infiltrative. Inflammatory changes of an articulate bag, in the beginning local, then widespread are the cornerstone of process. Infiltration, hypostasis and increase in friability of a sinovialny cover is noted. Sinoviya becomes viscous, muddy, its quantity increases.
- Pyoinflammatory. Arises after infection of sinovialny liquid. Hypostasis of soft fabrics amplifies, in the field of a sinovialny cover certain sites of a necrosis, in the subsequent merging among themselves appear. Massive infiltration of soft fabrics, increase in amount of liquid in a joint is found.
- Bone and articulate destruction. Cartilages, and then and the subject bone structures are involved in purulent process in the beginning. Toxic influences and violation of food of fabrics as a result of hypostasis provokes fragmentation and the subsequent final fracture of cartilaginous tissue. Osteomyelitis of the articulate ends of phalanxes develops, articulate the felon is transformed in bone and articulate.
Symptoms of an articulate felon
The main complaint of patients is the intensive pain syndrome. The pains which are pulling, holding apart, interrupting a night sleep, amplifying when lowering a brush. At survey local puffiness of soft fabrics is found. Integuments are hyperemic. The finger has the characteristic spindle-shaped form which is especially expressed in pyoinflammatory and destructive phases, is in the provision of insignificant bending. The active movements are impossible, passive are sharply painful. The palpation on a palmar and back surface is painful, at palpation by the pugovchaty probe the area of morbidity has an appearance of the ring located in a joint projection. Pains are also determined at axial loading and attempt of extension of a finger by an axis.
At sharp process symptoms of the general intoxication come to light. Temperature increase of a body to febrilny figures is observed, patients note weakness, weakness, lack of appetite, a headache, sometimes – oznoba. At a chronic inflammation in a zone of a joint the svishchevy opening with purulent separated is found. The pathological mobility caused by fusion of fabrics in a defeat zone can be observed. Obshcheintoksikatsionny symptoms are expressed slightly or are absent (in dependence of efficiency of drainage).
At defeat of the ends of bones forming a joint there is a bone felon, at fusion of tendinous vaginas – tendinous. When involving all structures of a finger develops pandaktilit. Further progressing of an inflammation can become the reason of formation of phlegmon of a brush, a limfangit, lymphadenitis, in hard cases – sepsis. After elimination it is purulent - necrotic process more than at a half of patients restrictions of function of a brush of various degree of expressiveness come to light.
At primary articulate felon diagnostics is performed by the traumatologist, at secondary – the purulent surgeon. For diagnosis these conversations with the patient, results of objective survey and additional researches are used. The standard program of inspection includes the following events:
- Poll, survey. During the poll typical complaints become clear, in the anamnesis the injury of a joint or pyoinflammatory defeat of the next anatomical structures comes to light. At external survey the doctor pays attention to spindle-shaped deformation of a finger, a ring-shaped zone of morbidity, existence of the general signs of a purulent inflammation.
- Brush finger X-ray analysis. At an initial stage on roentgenograms consolidation of myagkotkanny educations is found: capsules, sheaves, hypodermic cellulose. Narrowing or expansion of an articulate crack is possible. In the subsequent in the field of the articulate ends there is osteoporosis. At the final stage the articulate crack is narrowed or is not looked through, borders between bone and cartilaginous tissue are absent, the osteomiyelitichesky centers in the articulate ends of the bones forming a joint are defined. Dislocation or an incomplete dislocation is possible.
- Laboratory analyses. In OAK the general inflammatory changes – with prevalence of young forms, increase in SOE are observed. At crops of separated piogenny microflora comes to light.
Articulate the felon is usually differentiated from other forms of a purulent inflammation of a finger, is more rare – from traumatic, gonorrheal, gouty or rheumatoid arthritis. In doubtful cases and in need of specification of a stage of pathological process carry out a joint puncture for assessment of character of sinovialny liquid. At suspicion of arthritis depending on an estimated etiology consultation of the rheumatologist or venereologist can be appointed.
Treatment of an articulate felon
Treatment of a disease is performed in the conditions of a surgical or traumatologic hospital. At the initial stage conservative maintaining is allowed. The joint is punktirut, in the presence of a serous exudate liquid is deleted, enter solutions of antibiotics into an articulate cavity, sometimes intra articulate introduction of medicines is supplemented intra bone. The hand is fixed plaster longety, suspended on a kosynochny bandage. Carry out the general antibiotic treatment, appoint analgetics. Usually even removal of 2-3 ml of liquid significantly facilitates a condition of the patient. Introduction of antibacterial means in some cases allows to prevent infection of sinovialny liquid and to prevent further development of process.
At a purulent exudate, the expressed symptoms of the general intoxication surgical intervention is required. Operation is performed under anesthetic or conduction anesthesia. Make for broad opening of an articulate cavity one or two sections at the level of a joint. The cavity is washed out solutions of antibiotics. In the presence of regional sequesters carry out a resection. Drainages at an articulate felon do not establish because of risk of damage of articulate surfaces and negative impact on the speed of restoration of fabrics. In the subsequent carry out daily washings against the background of antibiotic treatment and fixing of the struck segment in functionally advantageous position. After healing of a wound according to indications carry out reconstructive interventions.
Forecast and prevention
At an initiation of treatment in a stage of infiltration and successful prevention of suppuration of an exudate the absolute recovery becomes an outcome. When progressing process to the second and but the third stage after elimination of suppuration dysfunction of a finger is usually observed. The most widespread consequences are contractures and rigidity, ankiloza come to light less often. Prevention of an articulate felon consists in prevention of home and production accidents of fingers of a brush, the timely request for medical care, correction of the immune violations and other states increasing risk of developing of this pathology.