title: Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review.
abstract: OBJECTIVE
  The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries.
  
  
  METHODS
  MEDLINE, Scopus and CINAHL were used as the literature sources.
  
  
  METHODS
  Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication.
  
  
  METHODS
  Case studies, case series and review articles were not included.
  
  
  RESULTS
  After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each.
  
  
  CONCLUSIONS
  Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs.
  PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).
authors.affiliation: Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia. hamish.smith@my.jcu.edu.au.
authors.forename: H R
authors.initials: HR
authors.lastname: Smith
authors.affiliation: Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Hartman
authors.affiliation: Department of Orthopaedic Surgery, Cairns Hospital, Cairns, QLD, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Loveridge
authors.affiliation: Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Gunnarsson
mesh_terms: D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D005383:Finger Injuries / Q000382:microbiology / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007592:Joint Diseases / Q000382:microbiology / Q000628:therapy*; D009055:Mouth / Q000382:microbiology; D012307:Risk Factors; D013708:Tendon Injuries / Q000382:microbiology / Q000628:therapy*; D018677:Tooth Injuries; D014754:Violence; D014950:Wounds, Penetrating / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Amputation; Clenched fist injury; Fight bite; Health care costs; Tooth-knuckle injury