Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries

Smith, H. R.; Conyard, Christopher; Loveridge, J.; Gunnarsson, Ronny

doi:10.1142/s2424835519500024

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…Fight bite or clenched-fist injuries can result in devastating consequences if not recognized appropriately. [1][2][3][4][5] This is complicated by the anatomy of the MCPJ, the mobile overlying skin, and the dynamics of the injury mechanism, which can make it difficult for surgeons to recognize deep injury and traumatic arthrotomy. 2,4 The saline load test is routinely used to recognize traumatic arthrotomies of other joints [9][10][11][12] ; however, to our knowledge, there were previously no studies evaluating this test for MCPJs.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] This injury can have devastating consequences, including infection of the surrounding soft tissues as well as a septic joint. [1][2][3][4][5] When not expeditiously identified, these injuries can lead to significant irreversible dysfunction. [5][6][7] Therefore, it is imperative that surgeons recognize arthrotomies and manage them appropriately, as urgent surgical debridement can prevent poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] When not expeditiously identified, these injuries can lead to significant irreversible dysfunction. [5][6][7] Therefore, it is imperative that surgeons recognize arthrotomies and manage them appropriately, as urgent surgical debridement can prevent poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies

Chughtai

Scollan

Brej

et al. 2022

Hand (New York, N,Y.)

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Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation( P > .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required > 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies

Chughtai

Scollan

Brej

et al. 2022

Hand (New York, N,Y.)

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Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management

Dargan,

Wyman,

Bhoora

et al. 2024

Hand (New York, N,Y.)

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Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty. Level of Evidence: IV.

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Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries

Cited by 2 publications

References 17 publications

The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies

The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies

Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management

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