Human Bite

• Incidence (1)
  • 2%-23% of all bites
• Mechanism of injury (2,3)
  • Most likely sustained during a fight (clenched fist to mouth with teeth penetrating MCPJ) AKA "Fight Bite"
  • Can also be a direct bite.
• Polymicrobial (4)
  • Staphylococcus, Streptococcus viridans(alpha haemolytic), Streptobacillus, Eikenella corrodens, anaerobes e.g. Bacteroides.
  • Risk of septic arthritis or osteomyelitis

Specific to Human Bites:

• Note down the mechanism of trauma
  • If fight bite:
    • assess extensor tendon function
    • possible pain with passive movement of MCPJ or axial loading
• Imaging
  • AP, LAT, OBL
  • Look for any foreign objects

GENERAL (5,6,7):

• Instruct to be nil by mouth
• Remove rings
• Give antibiotics (as per local guidelines)
• Pain relief
• Tetanus prophylaxis (as per local guidelines)

WOUND CARE:

• Washout the wound with running water
  • If painful, consider using local anaesthetic to allow thorough washout
• If there is cellulitis present use a pen marker to draw at the edges for progression assessment.
• Apply a suitable dressing
  • 1^stlayer: non-adherent eg. adaptic or atrauman
  • 2^ndlayer: padding eg. gauze
    • Enough to hold the amount of exudate likely to come from the wound in order to prevent strike through
  • 3^rdlayer: tape/plaster
• Provide a high arm sling
  • Hand should be above the heart

DISCUSS WITH SENIOR:

LIKELY TO REQUIRE ADMISSION