title: The management of clenched fist 'fight bite' injuries of the hand.
abstract: We present a prospective study outlining the management of clenched fist 'fight bite' injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries. The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes. A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK davidshewring@me.com.
authors.forename: D J
authors.initials: DJ
authors.lastname: Shewring
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Trickett
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: K N
authors.initials: KN
authors.lastname: Subramanian
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hnyda
mesh_terms: D000293:Adolescent; D000328:Adult; D001733:Bites and Stings / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001914:Boxing / Q000293:injuries*; D003646:Debridement; D005260:Female; D006230:Hand Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D050823:Hand Joints / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
keywords: Human bite; fight-bite; septic arthritis