Natural history and treatment of pulp space infection and osteomyelitis of the terminal phalanx.

Infection of the pulp space occurs with much greater frequency than more serious infections of the palmar space or tendon sheaths, and it may cause prolonged incapacity. There is often residual disability due to stiffness of joints, fibrosis of the tactile pad, or “ minor causalgia “ with a cold, blue, shiny and stiffened finger, aching pain of a “ deep cold “quality and tactile hyperpathia. These cases are obviously important from a social and organisational standpoint. Statistics prepared for us by Professor R. A. Lane show that of all claims made under the Workmen’s Compensation Act approximately 24 to 5 per cent. were for septic hand lesions. Our own analysis of 1,979 patients seen in 1947 with hand infections indicates that 22 per cent. were pulp space infections, whereas only two cases were infections of tendon sheaths and five were infections of the palmar space (Table I).