Closed fist infection

Background

• 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)

Diagnosis

• Imaging indicated to rule-out fracture, tooth fragments

Treatment

• 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

See Also

• Hand Infection

Source

Tintinalli