Closed fist infection: Difference between revisions
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*Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints) | *Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints) | ||
== | ==Differential Diagnosis== | ||
*[[Hand Fracture]] | *[[Hand Fracture]] | ||
{{Template:Hand Infection DDX}} | {{Template:Hand Infection DDX}} | ||
Revision as of 22:13, 17 November 2014
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
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
- 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
Tintinalli