Treatment of infected clench-fist human bite wounds in the area of metacarpophalangeal joints.

We reviewed the cases of 221 patients with infected clench-fist human bite wounds in the area of metacarpophalangeal joints. If the joint's capsule was not violated (79 patients), the wound was debrided and irrigated using an antiseptic solution. The would was drained with microirrigators and closed primarily. A second group of 53 patients in whom the joint had been violated but without osseous or articular involvement were treated with debridement, irrigation, drainage, and skin closure. A third group with articular and/or bone destruction (89 patients) was treated the same way as group 2 with the addition of a distraction device to fix and "unload" the joint. In the first group, 71 patients had excellent results and 2 had satisfactory results (6 were lost to follow-up examination). In the second group, 38 patients had excellent results, 7 patients had satisfactory results, and 2 had unsatisfactory results (six patients were lost to follow-up examination). In the third group, 39 patients had excellent results, 24 had satisfactory results, and 10 had unsatisfactory results (16 patients were lost to follow-up examination).