CLENCHED FIST INJURY (FIGHT BITE)

Question 1

DOCUMENTATION

Answer 1

HISTORY
Mechanism: Most commonly striking another’s teeth with a clenched fist

RED FLAGS
Joint Space
Signs of Infection
Loss of Function

Occur in multiple planes

PHYSICAL

Look for signs of infection
Full ROM
Extensor Tendon Function:
extension against resistance at metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints.
Central Slip: Elson and Modified Elson test

Question 2

MANAGEMENT

Answer 2

INITIAL MANAGEMENT
Irrigate with copious water

XRAY
evaluate for: embedded teeth
air in the joint / soft tissues
fractures

MANAGEMENT UNCOMPLICATED: NO INFECTION

Do not suture
Pack puctures with ribbon gauze
heal by second intention
Splint hand in a position of function
Clavulin 875 mg
1 tab PO bid
5 days

Penicillin Allergy:
Flagyl + Doxycycline
Septra + Flagyl
Cipro + Flagyl

COMPLICATIONS

Rapid spread of infection to other compartments

Laceration of adjacent structures

MANAGEMENT: SIGNS OF INFECTION

Send any spontaneous exudate for Gram stain and culture

Immobilize and elevate the extremity

Ampicillin-Sulbactam
1.5 g IV q 6 h
OR
Pip-tazo
3.375 g q 6 h

Penicillin Allergy:
TMP-SMX and Metronidazole

Admit and consult plastics