Fight Bite Puncture Wounds
Fight Bite Injuries
They may occur over MCP joints of fingers caused by penetrating human tooth and may extend into joint causing cartilage injury ,bony fracture.
They may lead to Joint Infection and Osteomyelitis.
How to assess the problem ?
History - including circumstances of injury
Past Medical History
Tetanus Toxoid status
Examination - Fever , tachycardia,
- Local Examination
cellulitis
tenon sheath infection
tendon rupture
septic arthritis
Investigations
- X-ray of the hand - AP/Oblique
r/o fracture, foreign body
- Baseline blood investigations - CBC,ESR,CRP
Treatment
Tetanus Prophylaxis
Sterile Dressings to cover the wound
Antibiotics after tissue culture samples are taken (Broad spectrum and narrow down after c/s report )
Pus swab and tissue samples - sent for Histological examination and microbiological investigations.
Extend wound - look for tendon damage ,tag tendon ends and not to do primary repair
- inspect joint
Irrigation
Leave wound open, dressing, splinting
Which organisms cause the infection ?
Eikenella Corrodens - Peculiar
Staph Aureus -commonest
Anaerobic Bacteria may also be implied.
Which antibiotics is better ?
Before the C/S report , broad spectrum Abx such as Co-amoxiclav,Cephalosporin and Metronidazoles are given.
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