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Human Wrist Injuries
Figure 10—2. Unusual presentation of a human bite of

the ulna aspect of the hand affecting the 5th volar MP.

bite (Fig. 10-2). The most common site of injury is the third and fourth digits at the metacarpophalangeal joint. Osteochondral fractures are common.

Bite wounds to the hand may cause cellulitis and abscess. Human bite wounds are particularly virulent because of the gram-positive and anaerobic bacteria present in the mouth.

Nonsurgical Management

Patients who present less than 1 day following injury may not have signs of sepsis, and wound exploration and swabbing for aerobic and anaerobic cultures to determine antibiotic treatment may be sufficient. Treatment includes antibiotics and close observations. If their injury is treated within 8 hours, then the wound may be closed, whereas any wound after that time should be left open. Close observation in all cases must be performed. Antibiotics recommended may include penicillin G, ampicillin, carbeni-cillin, or tetracycline for E. corrodens, and a cephalosporin for Staphylococcus organisms. For dog bites, most suspected organisms are sensitive to penicillin. Tetanus prophylaxis should also be included with the use of antibiotics in dog bite injuries. The organism in cat bites, P. multocida, is usually sensitive to penicillin.

Surgical Management

In patients where treatment is delayed, signs of sepsis may be present. For these bite wounds, open joint drainage and irrigation may be necessary. A wide-open incision should be used for the irrigation and debridement. Several liters should be used in the irrigation. This is followed by close observation in the hospital and IV antibiotics.

Frequently the tooth will penetrate the metacarpophalangeal joint where the cartilage is particularly sensitive to infection. Every puncture wound near the proximal

Lumbrical Bar Splint
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