Closed fist infection: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints) | ||
*Many patients presents 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. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 14: | Line 16: | ||
==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | ===Work-up=== | ||
*Hand x-ray to | *Hand x-ray to evaluate for fracture, tooth fragments | ||
===Evaluation=== | ===Evaluation=== | ||
*Clinical diagnosis, based on history and physical exam | *Clinical diagnosis, based on history and physical exam | ||
*Need to maintain high clinical suspicion due to frequent delayed presentation | |||
==Management== | ==Management== | ||
*Copious irrigation | *Copious irrigation | ||
*Tdap (if >10 years since last booster<ref name="Perron" />) | |||
*Wound left open to heal by secondary intention | *Wound left open to heal by secondary intention | ||
**May require loose approximation if gaping | **May require loose approximation if gaping | ||
====[[Antibiotics]]==== | ====[[Antibiotics]]==== | ||
Prophylactic antibiotics should be initiated for all but the most superficial wounds | |||
{{Human bite antibiotics}} | {{Human bite antibiotics}} | ||
==Disposition== | ==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== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 08:56, 27 February 2016
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 presents 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
Diagnosis
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.