Human bites are most often reported on the hands and upper extremities (60 to 75 percent), head and neck (15 to 20 percent), trunk (10 to 20 percent), and lower extremities (5 percent) as the result of fighting.17 Passionate sexual activity can lead to bites on the penis, scrotum, and vulva. Self-inflicted bites are usually on the fingers, hands, and forearms. An occlusional bite, when human teeth bite through the body part, commonly occurs at the distal portion of a digit during an altercation and may result in complete amputation. The "clenched-fist" injury (CFI) occurs on the dorsum of the metacarpophalangeal region of the fist as it strikes the mouth and teeth of another individual.18 Human bites to the hands have serious sequelae, including infection, loss of function, and potential amputation if untreated or misdiagnosed. In the ED, patients may try to conceal or even deny the true etiology of human bite wounds. The ED physician should be suspicious, especially when confronted by any small laceration over the dorsum of the metacarpophalangeal joint, that such an injury should be considered a CFI until proven otherwise.
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