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Updated: Mar 2 2025

Human Bite

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https://upload.orthobullets.com/topic/6104/images/bite-fig7[1].jpg
  • summary
    • Human Bite wounds are associated with infections of the hand due to presence of various aerobic and anerobic pathogens.
    • Diagnosis is made by history and presence of open wounds most commonly over the dorsal aspect of the 3rd or 4th MCP joint.
    • Treatment is generally surgical debridement and antibiotics (must protect against aerobic and anaerobic bacteria).
  • Epidemiology
    • Incidence
      • human bite wounds to the hand consist of approximately 2% of bite wounds
        • third most common bite behind dog and cat
    • Demographics
      • more common in males
    • Location
      • typically dorsal aspect of 3rd or 4th MCP joint
        • "fight bite"
  • Etiology
    • Pathophyiology
      • mechanism
        • most often result of direct clenched-fist trauma (from tooth) after punching another individual in the mouth
        • can also result from direct bite (i.e. child biting another child)
      • pathoanatomy
        • tooth penetrates capsule of MCP joint
          • flora (bacteria) from mouth enter joint
          • bacteria become trapped within joint as fist is released from clenched position
            • bacteria now caught under extensor tendon and/or capsule
      • microbiology
        • typically polymicrobial
        • most common organisms
          • alpha-hemolytic streptococcus (S. viridans) and staphylococcus aureus
          • eikonella corrodens in 7-29%
          • other gram negative organisms
    • Associated conditions
      • extensor tendon lacerations
        • can be missed due to proximal tendon retraction
  • Presentation
    • History
      • direct clenched-fist trauma to another individual's mouth
        • often overlooked
        • must have high index of suspicion as patients often unwilling to reveal history
        • consider the injury a "fight-bite" until proven otherwise
      • possible delay in presentation until symptoms become intolerable
    • Symptoms
      • progressive development of pain, swelling, erythema, and drainage over wound
    • Physical exam
      • fight bite
        • small wound over dorsal aspect of MCP joint
          • wound often transverse, irregular
          • typically 3rd and/or 4th MCPs, but can involve any digit
          • erythema, warmth, and/or edema overlying wound and joint
          • ± purulent drainage
        • must assess for integrity of extensor tendon function
        • possible pain with passive ROM of MCP joint
        • typically no involvement of volar/flexor surface of digit
        • neurovascular status typically preserved
  • Imaging
    • Radiographs
      • indicated to assess for foreign body (i.e. tooth fragment) and for fracture
  • Studies
    • Culture
      • not routinely obtained in ED due to contamination
      • deep culture obtained in OR
        • aerobic and anaerobic
  • Diagnosis
    • Clinical
      • diagnosis is made with careful history and physical examination
  • Treatment
    • Operative
      • I&D, IV antibiotics
        • indications
          • fight bite
          • joints or tendon shealths are involved
        • antibiotics
          • IV antibiotics directed at Staph, Strep, and gram-negative organisms
            • ampicillin/sulbactam (unasyn)
          • PO antibiotics upon discharge for 5 to 7 days
            • amoxicillin/clavulanic acid (augmentin)
        • debridement
          • debridement of wound and joint capsule
          • wound left open for drainage
          • obtain gram stain and culture
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Question
1 of 1
In scope icon N/A
QID 219789 (Type "219789" in App Search)
A 71-year-old female presents to the clinic with complaints of left thigh start-up pain. She originally had a left total hip arthroplasty performed by an outside surgeon 10 years ago. A current radiograph is shown in Figure A. She is diagnosed with aseptic loosening of the femoral component. After a negative infectious workup, she is indicated for a revision total hip arthroplasty. Intraoperatively, the surgeon plans to perform an extended trochanteric osteotomy to facilitate the removal of the current implant and the cement mantle. The surgeon is concerned with proximal migration of the osteotomy fragment. What surgical technique can help mitigate the risk of proximal trochanteric migration?
  • A

Abduction of the hip 25-30 degrees during trochanteric reduction and fixation

22%

143/652

Limiting the osteotomy length to less than 10 cm

7%

45/652

Placing a cerclage cable distal to the planned osteotomy site

8%

51/652

Supplementing fixation with cortical strut allograft

4%

26/652

Utilizing plate fixation in addition to cerclage cables

58%

376/652

  • A

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Hand⎪ Human Bite
  • Hand
  • - Human Bite
7:21 min
10/5/2020
374 plays
5.0
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