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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