Closed fist infection

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%)

Clinical Features

• Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)

Differential Diagnosis

• Hand and finger fractures

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

• Digital mixoid cyst

Diagnosis

Work-up

• Hand x-ray to rule-out fracture, tooth fragments

Evaluation

• Clinical diagnosis, based on history and physical exam

Management

• Copious irrigation
• 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

See Also

• Hand infection
• Animal bites