Closed fist infection
- 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%)
- Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
- Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM
- May also have systemic symptoms such as fever, lymphadenopathy, etc.
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Herpetic whitlow
- Flexor tenosynovitis
- Hand x-ray to evaluate for fracture, tooth fragments
- Clinical diagnosis, based on history and physical exam
- Need to maintain high clinical suspicion due to frequent delayed presentation
- Copious irrigation
- Tdap (if >10 years since last booster)
- Wound left open to heal by secondary intention
- May require loose approximation if gaping
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, Peptostreptococcus
- Amoxicilin-clavulanate 875mg PO BID x 5-7days OR
- Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
- 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.
- Patzakis, M, et al. Surgical findings in cleenched-fist injuries. Clin Ortho Relat Res. 1987; 200:237-240.
- 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