Closed fist infection: Difference between revisions
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==Background== | ==Background== | ||
*Also known as a "Fight Bite" | [[File:Wrist and hand deeper palmar dissection.svg|thumb|Wrist and hand deeper palmar dissection]] | ||
*Also known as a "Fight Bite" or "Reverse Bite Injury" | |||
*Result of striking another individual's teeth with clenched fist | *Result of striking another individual's teeth with clenched fist | ||
*Although may appear benign, significant morbidity can result from late presentation or inadequate initial management | *Although may appear benign, significant morbidity can result from late presentation or inadequate initial management | ||
*Complications are frequent and include joint violation (68%), tendon injury (20%), and fracture (17%)<ref>Patzakis, M, et al. Surgical findings in cleenched-fist injuries. Clin Ortho Relat Res. 1987; 200:237-240.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
* | [[File:PMC4908226 gr1.png|thumb|Clenched fist injury complicated by infection.]] | ||
[[File:PMC5078834 atr-05-03-32933-g001.png|thumb|Fight bite with metacarpal neck fracture.]] | |||
[[File:PMC4725650 PAMJ-22-71-g001.png|thumb|Infected wound on the dorsum of the left hand in front of the MP joint of the index following a fist against the teeth]] | |||
*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints) | |||
*Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">Perron,A et al. Orthopedic pitfalls in the ED: Fight bite. The American Journal of Emergency Medicine. Volume 20, Issue 2, March 2002, Pages 114–117</ref> | |||
**May also have systemic symptoms such as fever, lymphadenopathy, etc. | |||
==Diagnosis== | ==Differential Diagnosis== | ||
* | *[[Hand and finger fractures]] | ||
{{Template:Hand Infection DDX}} | |||
== | ==Evaluation== | ||
*Prophylactic | ===Work-up=== | ||
* | *Hand x-ray to evaluate for fracture, tooth fragments | ||
** | |||
===Evaluation=== | |||
* | *Clinical diagnosis, based on history and physical exam | ||
*Need to maintain high clinical suspicion due to frequent delayed presentation | |||
==Management== | |||
*Copious irrigation | |||
*Tdap (if >10 years since last booster<ref name="Perron" />) | |||
*Wound left open to heal by secondary intention | |||
**May require loose approximation if gaping | |||
====[[Antibiotics]]==== | |||
Prophylactic antibiotics should be initiated for all but the most superficial wounds | |||
{{Human bite antibiotics}} | |||
==Disposition== | |||
*Admit with IV antibiotics and hand surgery consultation if: | |||
**Delayed presentation, evidence of local infection, systemic symptoms | |||
*Otherwise, discharge with PO antibiotics, close follow-up, and strict return precautions. | |||
==See Also== | ==See Also== | ||
*[[Hand | *[[Hand infection]] | ||
*[[Animal bites]] | |||
== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 20:24, 29 April 2020
Background
- Also known as a "Fight Bite" or "Reverse Bite Injury"
- Result of striking another individual's teeth with clenched fist
- Although may appear benign, significant morbidity can result from late presentation or inadequate initial management
- Complications are frequent and include joint violation (68%), tendon injury (20%), and fracture (17%)[1]
Clinical Features
- Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
- Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM[2]
- May also have systemic symptoms such as fever, lymphadenopathy, etc.
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Evaluation
Work-up
- Hand x-ray to evaluate for fracture, tooth fragments
Evaluation
- Clinical diagnosis, based on history and physical exam
- Need to maintain high clinical suspicion due to frequent delayed presentation
Management
- Copious irrigation
- Tdap (if >10 years since last booster[2])
- Wound left open to heal by secondary intention
- May require loose approximation if gaping
Antibiotics
Prophylactic antibiotics should be initiated for all but the most superficial wounds Requires polymicrobial coverage for: S. aureus, Strep Viridans, Bacteroides, Coagulase-neg Staph, Eikenella, Fusobacterium, Cornebacterium, peptostreptococus
- Amoxicilin-clavulanate 875mg PO BID x 5-7days OR
- Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
- Ciprofloxacin 500mg PO q12hrs x 7 days OR
- TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
Disposition
- Admit with IV antibiotics and hand surgery consultation if:
- Delayed presentation, evidence of local infection, systemic symptoms
- Otherwise, discharge with PO antibiotics, close follow-up, and strict return precautions.