Closed fist infection: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Copious irrigation | |||
#Wound left open to heal by secondary intention - May require loose approximation | |||
#Prophylactic abx should be initiated for all but the most superficial wounds | |||
#*If no visible signs of infection: | |||
#**[[Amoxicillin/Clavulanate]] 875/125mg PO BID x5d | |||
#*For signs of infection: | |||
#**[[Ampicillin/Sulbactam]] 1.5gm IV q6h OR [[cefoxitin]] 2gm IV q8h OR [[Piperacillin/Tazobactam]] 3.375gm q6h | |||
#**Penicillin allergy: [[clindamycin]] plus [[ciprofloxacin]] | |||
#**Consider hand specialist consult for open irrigation and debridement with possible admission for IV abx | |||
==See Also== | ==See Also== | ||
Revision as of 01:23, 12 March 2015
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
- Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
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
Diagnosis
- Imaging indicated to rule-out fracture, tooth fragments
Treatment
- Copious irrigation
- Wound left open to heal by secondary intention - May require loose approximation
- Prophylactic abx should be initiated for all but the most superficial wounds
- If no visible signs of infection:
- Amoxicillin/Clavulanate 875/125mg PO BID x5d
- For signs of infection:
- Ampicillin/Sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR Piperacillin/Tazobactam 3.375gm q6h
- Penicillin allergy: clindamycin plus ciprofloxacin
- Consider hand specialist consult for open irrigation and debridement with possible admission for IV abx
- If no visible signs of infection:
See Also
Source
- ↑ Patzakis, M, et al. Surgical findings in cleenched-fist injuries. Clin Ortho Relat Res. 1987; 200:237-240.