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clenched fist injury; closed fist injury; reverse bite injury; fight bite
Etiology:
- injury that occurs when a person punches the mouth of another person
Pathology:
- hand laceration resulting in crush injury of the hand & entry of oral bacteria into multiple tissue layers
- high risk for infection, especially along the extensor tendon sheath or in the metacarpophalangeal joint
- tendon laceration may also occur
Laboratory:
- complete blood count (CBC)
- wound culture
- multiple organisms may be isolated
- Eikenella corrodens is often isolated
- blood cultures as indicated
Radiology:
- X-ray of injured hand
Complications:
- severity frequently underestimated
- may progress to osteomyekitis, tenosynovitis or septic arthritis
Management:
- consult hand surgeon
- treat as human bite
- consider hospitalization [1]
General
hand laceration
References
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Cimino-Fiallos N
14 Can't-Miss Hand Emergencies
Medscape. March 5, 2021
https://reference.medscape.com/slideshow/hand-emergencies-6010180