Hand Trauma Pitfalls: A Retrospective Study of Fight Bites.

Clench fist or fight bite injuries are associated with some of the worst types of infective complications but their mechanism is often poorly understood. In a retrospective case series, 34 patients seen between 1998 and 2004 presented to a local hand surgery unit with confirmed human bite hand injuries. Seventy-six percent presented with infective complications with a mean delay in presentation of 4 days. Eighty percent of patients were clench fist injuries (CFI) (open joints in 59% and tendon injuries in 63%). Using an aggressive treatment policy including early surgical and antibiotic intervention, most patients achieved good results functionally (full range of movement was achieved in 83% of those with CFI which completed follow-up (44%)). High rates of non-compliance and incomplete follow-up was noted. Major long-term complications including limited range of movement and osteomyelitis was low and suggests the policy of prompt and comprehensive surgical and medical intervention is the optimal treatment option. A brief but in-depth discussion of the specific anatomical pitfalls is included.