Closed fist infection: Difference between revisions
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#Wound left open to heal by secondary intention | #Wound left open to heal by secondary intention | ||
#*May require loose approximation | #*May require loose approximation | ||
====[[Antibiotics]]==== | |||
*Prophylactic [[antibiotics]] should be initiated for all but the most superficial wounds | |||
{{Human bite antibiotics}} | |||
==See Also== | ==See Also== | ||
Revision as of 02:19, 28 April 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
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
See Also
Source
- ↑ Patzakis, M, et al. Surgical findings in cleenched-fist injuries. Clin Ortho Relat Res. 1987; 200:237-240.