- clenched fist injury
- infections of the hand
- bacteriology of hand infections:
- bites distal to the wrist are at higher risk for malignant infections due to the proximity of superficial spaces, flexor tendons, and joints;
- besides considering tetatnus also consider Hep B.
- need to treat for staph, strep, and eikenella infections;
- prophylactic treatment: augmentin / amoxicillin or with allergy (cipro + clindamycin)
- w/ estabilished infection: unasyn or with allergy (cipro + clindamycin) or ceftriaxone
- offending organisms:
- see: bacteriology of hand infections;
- strep - viridans strep, grp a strep, staph aureus, eikenella corrodens, bacteriodes, fusobacterium, actinomycetes, spirochetes;
- alpha-hemolytic streptococci are the most frequent isolates from human bite wounds;
- anaerobic bacteria are commonly found in all types of infected bites;
- borrelia vincentii is a spirochete that may appear in association w/ w/ bacteroides;
- in bites inflicted by hospitalized patients, consider enterobacteriaceae
- Eikenella corrodens in hand infections.
- references:
- A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines.
- Hand infections. Bacteriology and treatment: a prospective study.
- Human bites of the hand: twenty years of experience.
- Human bites in children. A six-year experience.
- Osteomyelitis of the hand after a human bite.
- A functional treatment method for interphalangeal pyogenic arthritis.
- Bacteriology of human and animal bite wounds.
- Management of human and animal bite wound infection: an overview
- Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients.
- Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries
- Comparison of the epidemiology of human bites evaluated at three US pediatric emergency departments.
- The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon
- Dog-bite lacerations: a controlled trial of primary wound closure
- Primary closure of mammalian bites