Hand Trauma Pitfalls: A Retrospective Study of Fight Bites

Goon, Patrick K. Y.; Mahmoud, Matti; Rajaratnam, Vaikunthan

doi:10.1007/s00068-007-6183-9

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…In our series, the vast majority of infections occurred after trauma, such as injuries related to job or household activities or animal bites. Of interest and in contrast to other reports [15], no fight bite was noted within our cohort.…”

Section: Discussioncontrasting

confidence: 88%

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Meier¹,

Wirth²,

Hahn

et al. 2017

Open Forum Infectious Diseases

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Background.Pyogenic arthritis of the small joints of the hand and wrist is a known but poorly described entity. The objective of this work was to characterize the clinical presentation, antimicrobial treatment, and surgical interventions of native small joint arthritis (SJA) treated in our tertiary center.Methods.According to predefined variables, medical records of adult patients with SJA treated in a Swiss university hospital between 2005 and 2013 were retrospectively analyzed.Results.The median age of 97 patients (101 joints) was 52 years (interquartile range [IQR], 38–68 years); 52% had no comorbidity. Small joint arthritis of the second and third fingers accounted for 53% of infections, with metacarpal-phalangeal and proximal interphalangeal joints most commonly involved. Of 86 (89%) episodes with an exogenous source, 63 (65%) followed a trauma. The most commonly isolated microorganism was Staphylococcus aureus (38%), followed by β-hemolytic streptococci (13%) and Pasteurella spp (11%). Eighty-seven episodes (89 joints) in patients with follow-up examinations were included in treatment and outcome analyses. Up to 2 surgical interventions were required to cure infection in 74 (83%) joints. Median antimicrobial treatment duration was 14 days (IQR, 12–28 days), with amoxicillin/clavulanate administered in 74 (85%) episodes. At follow up, cure of infection was noted in all episodes and good functional outcome in 79% of episodes.Conclusions.Small joint arthritis shows considerable differences from clinical patterns reported for larger joints. In our series, the outcome was good with no more than 2 surgical interventions and median treatment duration of 14 days in 79% of episodes.

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Section: Discussioncontrasting

confidence: 88%

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Meier¹,

Wirth²,

Hahn

et al. 2017

Open Forum Infectious Diseases

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show abstract

“…14,15 Specifically, delay to presentation has been associated with longer duration of admission, necessity of multiple operative debridements, and a higher incidence of osteomyelitis. 16 The limitations of this study include its retrospective nature and the lack of long-term follow-up. Unfortunately this is to be expected given the high rate of loss to follow-up in this patient population.…”

Section: Discussionmentioning

confidence: 98%

Challenging Dogma: Optimal Treatment of the “Fight Bite”

Harper

Dowlatshahi

Rozental

2019

Hand (New York, N,Y.)

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Background: The optimal treatment of human bites to the dorsal metacarpophalangeal region (ie, “fight bite”) in the absence of gross purulence is controversial. Few studies have compared the outcomes of operative debridement with expectant wound care and oral antibiotics. Methods: We performed a retrospective chart review of all patients evaluated at a Level 1 trauma center over a 10-year period. We compared demographic and clinical characteristics of patients across treatment and outcome groups using the Fisher exact test. Logistic regression models were used to describe the relationships between the outcome and treatment variables. Results: We identified 115 patients with a mean age of 29 years. The mean follow-up was 51.8 days. Seventy-two (63%) patients were treated with antibiotics only. Thirty-two (28%) patients were treated with irrigation in the emergency department (ED) and expectant wound care. Eleven (9%) patients were treated with irrigation and debridement in the operating room. No demographic variables were found to correlate with the treatment selected. A 12% complication rate (major and minor) was observed. After adjusting for duration of follow-up and days to presentation, neither the treatment rendered nor the antibiotics selected influenced the rate of complications. Time to presentation >24 hours was the only variable associated with higher complication rate ( P = .003). Conclusions: Not all fight bites require operative intervention. Irrigation in the ED with expectant wound care and oral antibiotics can be sufficient for patients presenting within 24 hours of injury in the absence of gross purulence.

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“…Our amputation rates are low at only 1.6%, but other recent studies have also identified low amputation rates possibly due to increased awareness of the injury. 3,13,14) This study suffered from some limitations. The data was collected retrospectively and when originally collected was not done so in a standardised manner possibly introducing information bias.…”

Section: Discussionmentioning

confidence: 99%

Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries

Smith

Conyard

Loveridge

et al. 2019

J Hand Surg Asian-Pac Vol

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Background: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury.Methods: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements.Results: Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements.Conclusions: Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury.

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Hand Trauma Pitfalls: A Retrospective Study of Fight Bites

Cited by 10 publications

References 23 publications

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Challenging Dogma: Optimal Treatment of the “Fight Bite”

Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries

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