Closed fist infection - Revision history

Rossdonaldson1: /* Background */

2020-04-29T20:24:21Z

Background

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	==Background==		==Background==
			[[File:Wrist and hand deeper palmar dissection.svg\|thumb\|Wrist and hand deeper palmar dissection]]
	*Also known as a "Fight Bite" or "Reverse Bite Injury"		*Also known as a "Fight Bite" or "Reverse Bite Injury"
	*Result of striking another individual's teeth with clenched fist		*Result of striking another individual's teeth with clenched fist

Rossdonaldson1: /* Clinical Features */

2020-01-28T21:43:01Z

Clinical Features

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	[[File:PMC4908226 gr1.png\|thumb\|Clenched fist injury complicated by infection.]]		[[File:PMC4908226 gr1.png\|thumb\|Clenched fist injury complicated by infection.]]
	[[File:PMC5078834 atr-05-03-32933-g001.png\|thumb\|Fight bite with metacarpal neck fracture.]]		[[File:PMC5078834 atr-05-03-32933-g001.png\|thumb\|Fight bite with metacarpal neck fracture.]]
			[[File:PMC4725650 PAMJ-22-71-g001.png\|thumb\|Infected wound on the dorsum of the left hand in front of the MP joint of the index following a fist against the teeth]]
	*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)		*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<ref name="Perron">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</ref>		*Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>

Rossdonaldson1: /* Clinical Features */

2020-01-28T21:38:09Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	[[File:PMC4908226 gr1.png\|thumb\|Clenched fist injury complicated by infection.]]		[[File:PMC4908226 gr1.png\|thumb\|Clenched fist injury complicated by infection.]]
			[[File:PMC5078834 atr-05-03-32933-g001.png\|thumb\|Fight bite with metacarpal neck fracture.]]
	*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)		*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<ref name="Perron">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</ref>		*Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>

Rossdonaldson1: /* Clinical Features */

2019-12-11T03:40:25Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
			[[File:PMC4908226 gr1.png\|thumb\|Clenched fist injury complicated by infection.]]
	*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)		*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<ref name="Perron">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</ref>		*Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>

Josgood: /* Clinical Features */

2017-06-19T16:16:52Z

Clinical Features

← Revisión anterior		Revisión del 16:16 19 jun 2017
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	==Clinical Features==		==Clinical Features==
	*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)		*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
	*Many patients ~~presents~~ 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>		*Many patients present 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>
	**May also have systemic symptoms such as fever, lymphadenopathy, etc.		**May also have systemic symptoms such as fever, lymphadenopathy, etc.

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T00:04:01Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

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	{{Template:Hand Infection DDX}}		{{Template:Hand Infection DDX}}

	==~~Diagnosis~~==		==Evaluation==
	===Work-up===		===Work-up===
	*Hand x-ray to evaluate for fracture, tooth fragments		*Hand x-ray to evaluate for fracture, tooth fragments

Ostermayer: Text replacement - "Category:Ortho" to "Category:Orthopedics"

2016-03-22T15:47:17Z

Text replacement - "Category:Ortho" to "Category:Orthopedics"

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	[[Category:ID]]		[[Category:ID]]
	[[Category:~~Ortho~~]]		[[Category:Orthopedics]]

Mholtz at 08:56, 27 February 2016

2016-02-27T08:56:28Z

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	==Clinical Features==		==Clinical Features==
	*~~Pain/swelling~~ over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)		*Laceration over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
			*Many patients presents 5-7 days after injury with healing wound, pain/swelling, erythema, limited ROM<ref name="Perron">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</ref>
			**May also have systemic symptoms such as fever, lymphadenopathy, etc.

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Diagnosis==		==Diagnosis==
	===Work-up===		===Work-up===
	*Hand x-ray to ~~rule-out~~ fracture, tooth fragments		*Hand x-ray to evaluate for fracture, tooth fragments

	===Evaluation===		===Evaluation===
	*Clinical diagnosis, based on history and physical exam		*Clinical diagnosis, based on history and physical exam
			*Need to maintain high clinical suspicion due to frequent delayed presentation

	==Management==		==Management==
	*Copious irrigation		*Copious irrigation
			*Tdap (if >10 years since last booster<ref name="Perron" />)
	*Wound left open to heal by secondary intention		*Wound left open to heal by secondary intention
	**May require loose approximation if gaping		**May require loose approximation if gaping

	====[[Antibiotics]]====		====[[Antibiotics]]====
	*Prophylactic antibiotics should be initiated for all but the most superficial wounds		Prophylactic antibiotics should be initiated for all but the most superficial wounds
	{{Human bite antibiotics}}		{{Human bite antibiotics}}

	==Disposition==		==Disposition==
	*		*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.

	==See Also==		==See Also==
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	==References==		==References==
	<references/>		<references/>


	[[Category:ID]]		[[Category:ID]]
	[[Category:Ortho]]		[[Category:Ortho]]

Mholtz at 09:49, 22 August 2015

2015-08-22T09:49:22Z

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	==Diagnosis==		==Diagnosis==
	*~~Imaging indicated~~ to rule-out fracture, tooth fragments		===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

	~~==Treatment==~~
	~~#Copious irrigation~~
	~~#Wound left open to heal by secondary intention~~
	~~#*May require loose approximation~~
	====[[Antibiotics]]====		====[[Antibiotics]]====
	*Prophylactic [[antibiotics]] should be initiated for all but the most superficial wounds		*Prophylactic antibiotics should be initiated for all but the most superficial wounds
	{{Human bite antibiotics}}		{{Human bite antibiotics}}

			==Disposition==
			*

	==See Also==		==See Also==
	*[[Hand ~~Infection~~]]		*[[Hand infection]]
	*[[Animal bites]]		*[[Animal bites]]

	==~~Source~~==		==References==
	<references/>		<references/>


	[[Category:ID]]		[[Category:ID]]
	[[Category:Ortho]]		[[Category:Ortho]]

Ostermayer: /* Treatment */

2015-04-28T02:19:07Z

Treatment

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	#Wound left open to heal by secondary intention		#Wound left open to heal by secondary intention
	#*May require loose approximation		#*May require loose approximation
	#Prophylactic [[antibiotics]] should be initiated for all but the most superficial wounds		====[[Antibiotics]]====
	~~#*If no visible signs of infection:~~		*Prophylactic [[antibiotics]] should be initiated for all but the most superficial wounds
	~~#**[[Amoxicillin/Clavulanate]] 875/125mg PO BID x5d~~		{{Human bite antibiotics}}
	~~#*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~~

	==See Also==		==See Also==