Rationale:

• Puncture wounds can penetrate bone and cause fractures or lead to osteomyelitis.
• Teeth can be left behind in a bite wound and need to be identified and removed for healing to occur.
• If there is evidence of tenosynovitis on examination, an ultrasound can help a hand surgeon determine if further surgical intervention is needed.
• Severe dog bite wounds to the head in children can cause significant injury to underlying structures.
• Although rare, dog bites to the head in infants can lead to underlying brain injuries than are not apparent on initial examination.
• Dog bites to the neck from a large dog can cause carotid dissection.

Evidence:

• Osteomyelitis can complicate dog, cat, and human bite wounds (27; 28; 29).
• Eleven of 12 cases of osteomyelitis from human bite wounds with clenched fists revealed tooth marks in the bone or cartilage (29).
• A retrospective review of 34 patients with cat or dog bites presenting to an emergency department showed bite wounds in six of nine late-presenting patients to be complicated by tenosynovitis (30).
• A retrospective review of 40 severe dog bites in children revealed that 82% involved the head and neck and 40% had underlying fractures (31).
• Of 15 reported cases of dog bites to infants causing skull fractures, 9 caused dural tears (32).

Comments:

• None.