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| Miscellaneous Disorders of the Hand & Upper Extremity > Animal Bites to the Hand What are Animal Bites to the Hand? Animal bites to the hand most frequently occur on the fingers of the dominant hand of children between the ages of 5 and 14. Dogs and cats inflict bite wounds most often, with the vast majority of these injuries caused by dogs. Women are bitten more frequently by cats, and men by dogs. Dogs have rounded teeth and strong jaws; the bite of an adult dog can exert up to 200 pounds per square inch of pressure. This pressure usually results in a crushing injury, causing damage to deep structures such as bones, blood vessels, tendons, muscles, and nerves. Dog bites result in infection 5 to 10% of the time. Cats have extremely sharp, pointed teeth and can inflict deep puncture wounds and lacerations. The risk of infection is much higher with cat bites (30 to 50%) because a cat's sharp teeth create deeper puncture wounds. The major concern of all bite wounds is subsequent infection. Nearly any group of pathogens, such as bacteria, virus, rickettsia, spirochetes, and fungi, can cause infection. Most all infections from animal bites are mixed infections, and can result in complications such as rabies, cellulitis, meningitis, osteomyelitis, and septic arthritis. In the United States, about 1% of dog bites and 6% of cat bites require hospitalization. With swift and proper care, the prognosis is usually very good for recovery from these injuries. Causes of Animal Bites to the Hand? There are as many as three million animal bites in the United States each year. Dogs are responsible for most animal bites in this country (up to 90%), with cat bites accounting for about 5% of such injuries. Other biting animals include rodents (at least 2%), rabbits, ferrets, farm animals, monkeys, and reptiles. Internationally, the types of animals inflicting bites can be quite exotic, including large cats such as tigers, lions, and leopards, wild dogs, hyenas, wolves, crocodiles, and other reptiles. Most bites, however, are from domestic dogs. In developing countries these dog bites carry a high risk of rabies infection. In the United States, unlike the rest of the world, wild animals such as bats, skunks, raccoons, and foxes spread more than 90% of rabies infection. Rabies is a generally fatal complication against which rapid inoculation has proven effective. A special concern regarding animal bites is the ongoing welfare of pediatric patients. Dogs and cats sometimes attack when they are eating, sleeping, or caring for their young. If a dog, cat, or other animal has bitten a child, is aggressive, or continues to be in a place where another bite could occur, the child is at risk. Removal of the animal to another location is advised. Symptoms of Animal Bites to the Hand? If the bite results in a puncture wound that is swollen, red, and painful, the wound is likely to be infected. Patients with infection may have an elevated temperature, swollen glands, or a history of fever. Any loss of motion or sensation in the fingers suggests that a tendon or nerve has been severed. If a flexor tendon has been severed, the patient will be unable to extend or flex some portion of the finger. When a nerve has been lacerated, there is a loss of sensation over the tip of the finger. Treatment of Animal Bites? General principles of contaminated wound management apply to animal bites to the hand. Even bites that appear innocuous at first may develop infection and should be looked at by a doctor. If you have experienced an animal bite to the hand, or are caring for a child who has been bitten, stop the bleeding by applying pressure to the wound, wash the injury thoroughly with soap and water, and apply a bandage. It is important to seek medical treatment immediately. Many tissues quickly lose their elasticity, and medical attention is necessary to prevent long-term damage. It is crucial to update your tetanus status if you have not had a booster shot within the past ten years, and to begin limiting the spread of infectious pathogens. The possibility of rabies must be addressed. Many areas require the reporting of bite wounds. Your doctor will examine the wound and ask about contributing factors to the injury. A complete history of the bite, including the type of animal and its status (general health, rabies vaccine, behavior), the time and location of the event, circumstances of the bite, whereabouts of the animal, and prehospital treatment, will be reviewed. If possible, tell your doctor whether a sudden movement towards the animal provoked the bite. Animals who initiate unprovoked attacks are more likely to be rabid. The attacking animal should be located, if possible, and observed under quarantine for 10 days. Your doctor will numb the area with an anesthetic block and explore the wound for injuries of the joint, tendon, and nerves. Medical intervention varies depending on the type of injury and the presence or absence of infection. Hands are complex parts of the body, comprised of many small interrelated parts, and x-rays are used to identify any damage to underlying deep structures, especially in the case of crushing bites affecting the joints. If an infected bite to the hand has gone untreated for a stretch of time, x-rays may reveal evidence of osteomyelitis, or the spread of infection to the bone. Animal bites to the hand require meticulous cleansing. Your doctor or other medical personnel will irrigate the wound with saline solution and debride it of devitalized tissue. Debriding involves the removal of any damaged skin, blood clots, or other particles that could be a source of infection. It is important to look for signs of lymphangitis, indicated by the presence of red streaks on the forearm. You doctor will palpate the inside of the elbow joint for evidence of enlarged lymph nodes. When the wound contains or is secreting pus, a culture will be taken of the purulent material. The use of antibiotics for animal bites depends on the particular circumstances of the injury, patient health and sensitivity to various medications, and the appearance of the wound. Some bites require the use of IV antibiotics, while others require no oral medication, only an antibiotic dressing to the wound. The presence of an underlying fracture usually dictates inpatient treatment. If you are diagnosed as having an infection of a flexor tendon sheath, or a severed tendon or nerve, you will be referred to an experienced hand surgeon. Early consultation is crucial in cases such as these, when hand surgery needs to be performed as soon as possible. After treatment, most animal bite wounds are wrapped with a bulky dressing or splint. You will be given instructions to elevate the hand. Mandatory follow-up visits usually occur at 24, 48, and 72 hours after treatment. You may be instructed to soak the wound periodically in warm water, changing the dressing each time. The use of ice massage and/or heat helps to alleviate discomfort as the wound heals, and specific exercises of the hand help you regain strength in the injured area. Follow-up care is crucial in the case of animal bite wounds, both to ensure that infection is diminishing or has not developed, and to restore the hand as much as possible to its former condition. As in the case of any potentially infectious wound, watch the injury and irrigate it well. Call your doctor if you experience any pain, swelling, drainage, or redness, or if you develop swollen glands or a fever. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. ©2000 DynoMed.com, LLC, Indianapolis, IN |