Clinical Features

The evaluation of human bites should identify the time interval since the injury, mechanism (i.e., occlusion versus closed fist), location, estimated depth of penetration, tetanus immunization status, medications, allergies, and underlying medical conditions predisposing to poor wound healing. As mentioned, human bites in the hands have an increased predilection for infection, but clinical signs of infection may not be present even after 24 h postinjury. Documentation of the vascular, motor, and sensory examination is essential. Following appropriate anesthesia, careful wound exploration is necessary to examine underlying structures for injury and possible foreign bodies. Examination of a CFI wound must take into account the flexed position at the interphalangeal and metacarpophalangeal joints at the time of injury; the injured segment of tendon will retract proximally in the unclenched, open hand and be missed if the physician evaluates the wound only in this position. The wound must be examined with the hand taken through a full range of motion at the metacarpophalangeal joint to detect extensor tendon injury. The joint capsule should be inspected to detect potential joint-space penetration. Radiographs should be taken of human bites to the hand, particularly CFI. Radiographs may disclose radiopaque foreign bodies (e.g., fragments of teeth), fractures, and air within the joint space (indicating joint-space penetration).

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