Closed fist infection: Difference between revisions
Ostermayer (talk | contribs) |
No edit summary |
||
| Line 13: | Line 13: | ||
==Diagnosis== | ==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]]==== | ====[[Antibiotics]]==== | ||
*Prophylactic | *Prophylactic antibiotics should be initiated for all but the most superficial wounds | ||
{{Human bite antibiotics}} | {{Human bite antibiotics}} | ||
==Disposition== | |||
* | |||
==See Also== | ==See Also== | ||
*[[Hand | *[[Hand infection]] | ||
*[[Animal bites]] | *[[Animal bites]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 09:49, 22 August 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
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
Disposition
See Also
References
- ↑ Patzakis, M, et al. Surgical findings in cleenched-fist injuries. Clin Ortho Relat Res. 1987; 200:237-240.