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| Miscellaneous Disorders of the Hand & Upper Extremity > Human Bites to the Hand What are Human Bites to the Hand? There are two major mechanisms of human bites to the hand. An example of penetrating trauma is a closed fist injury, in which one person strikes another in the mouth, causing a fight bite to the hand. If the hand is clenched in a fist, laceration of the skin over the knuckle may damage a tendon sheath or tendon, as well as surrounding tissue or underlying bones of the joint. Wounds over the fingers or other surfaces of the hand are the result of a direct and deliberate ("chomping") human bite. General principles of contaminated wound management apply to human bites. Human bite wounds contain higher concentrations of both aerobic and anaerobic bacteria than do animal bites. In addition to bacterial infection, they may transmit serious infectious diseases such as the HIV virus and hepatitis. Causes of Human Bites to the Hand? Victims of human bites are often reluctant to admit the cause of their injury, particularly if it was the result of a fight. Sometimes treatment is delayed for a day or two, until it is apparent that infection is likely. Because human bites can result in serious damage to the hand, it is important to seek prompt medical care. Reporting the mechanism of injury helps your doctor make an accurate diagnosis, ensuring swift and appropriate methods of treatment. Closed fist injuries are encountered almost exclusively in young males, usually occurring during adolescence through the fourth decade of life. While toddlers are notorious for biting each other, these injuries tend to be superficial and low-risk. As in the case of most intentional injuries, human bites are often the result of an incident involving alcohol. Domestic violence may be part of the picture. If a child has suffered a bite wound from an adult, child abuse must be taken into consideration. Symptoms of Human Bites to the Hand? Closed fist injuries often result in injury to the extensor tendon and its sheath. When a closed fist injury occurs to someone with a clenched fist, the bacterial load is often carried back into the hand as the tendon slides back to its relaxed state. This means that the problem of contamination cannot be easily resolved using normal methods of irrigating and cleaning a wound. Sometimes chomping injuries to the hand appear innocuous. Careful inspection is required to rule out the possibility of deep injury. If a flexor tendon has been severed, the patient will be unable to extend or flex some portion of the finger. If a nerve has been lacerated, there will be a loss of sensation over the tip of the finger. Patients with infection may have an elevated temperature, swollen glands, or a history of fever. Treatment of Human Bites to the Hand? If you have a human bite wound to the hand, 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 treatment 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 bacteria. Your doctor will examine the wound and ask about contributing factors to the injury. Again, honest reporting of the mechanism of injury is important, as it helps to ensure complete and proper care. Numbing the area with an anesthetic block, your doctor will explore the wound for injuries of the joint, tendon, and nerves. A tourniquet is often used to extend and assess the wound. Medical intervention varies depending on the presence or absence of infection. In the case of a closed fist injury, x-rays are typically used to determine the possibility of a fracture to the knucklebone (metacarpal head). The presence of an underlying fracture usually dictates inpatient treatment. 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. Routine laboratory studies are not usually indicated for human bite wounds, as the injured population is generally young and healthy. When the wound contains or is secreting pus, your doctor will probably obtain a culture of the bacteria. 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 for a consultation. Again, speed is of the essence. You will probably be given medication for pain relief, and in most cases, broad-spectrum antibiotic therapy will be initiated. It is important to take antibiotics for the entire course of the prescription. Many human bite wounds require the use of IV antibiotics, due to the deep nature of these infections and to the fact that tendons and other connective tissue of the hand have relatively poor vascular supply. If the bite wound has resulted in infectious tenosynovitis (infection of the flexor tendon sheath), or of a deep fascial space infection of the hand, incision and drainage will be needed to supplement treatment with antibiotics. An experienced hand surgeon should perform this surgery in an operating room. Anesthesia is used, and surgical risk increases with smoking and/or the use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids. Drink only water before surgery, following the instructions given to you by your doctor and other medical personnel. Your doctor will instruct you concerning surgical after-care. Wound management for human bite wounds to the hand usually requires careful cleansing of the injury, antibiotic coverage, a bulky dressing or splint, and instructions to elevate the hand. Early, mandatory follow-up visits are essential, usually occurring within one or two days. Most wounds are left open to allow for effective irrigation. Sometimes, at a later date, patients opt for plastic surgery if there has been significant tissue loss. You will probably 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 human bite wounds, both to ensure that infection is no longer present and to restore the hand as much as possible to its former condition. As in the case of any infection, watch the injury and irrigate it well. Call your doctor if you notice pain, swelling, drainage, or redness in the wound, 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 |