We present a prospective study outlining the management of clenched fist ‘fight bite’ injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries.
The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes.
A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.
J Hand Surg Eur Vol. 2015 Oct;40(8):819-24. doi: 10.1177/1753193415576249. Epub 2015 Mar 14. The management of clenched fist ‘fight bite’ injuries of the hand. Shewring DJ1, Trickett RW2, Subramanian KN2, Hnyda R2. 1Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK firstname.lastname@example.org. 2Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.