Rationale:

• Infected tendons, bones, or septic arthritis are difficult to eradicate with outpatient management alone.
• Outpatient management of infected human hand bites usually fails and ultimately leads to delayed hospitalization.
• Clenched fist wounds often appear as small lacerations, 3 to 5 mm in length on the surface, but often involve deep structures of the hand.
• Insufficient debridement and cleansing of human hand bite wounds by emergency department personnel not experienced in hand bite management can lead to under-treatment of hand wounds, ultimately increasing morbidity.

Evidence:

• A retrospective review of eight patients admitted for human hand bite infections showed that management failed in six patients initially treated in the outpatient setting, including treatment with oral antibiotics (34).
• In a prospective study of 100 human “fight-bite” injuries of the hand, the time till admission of the 18 who ultimately required amputation was 9.2 days in comparison to 4.6 days in those with healing without amputation (23).
• Twenty-three of 24 patients admitted with hand osteomyelitis from a human bite wound did not receive adequate surgical debridement within 24 hours of the injury (29).

Comments:

• None.