clenched fist injury; closed fist injury; reverse bite injury; fight bite

Etiology

• injury that occurs when a person punches the mouth of another person

Pathology

• hand laceration resulting in crush injury of the hand & entry of oral bacteria into multiple tissue layers
• high risk for infection, especially along the extensor tendon sheath or in the metacarpophalangeal joint
• tendon laceration may also occur

Laboratory

• complete blood count (CBC)
• wound culture
  • multiple organisms may be isolated
  • Eikenella corrodens is often isolated
• blood cultures as indicated

Radiology

• X-ray of injured hand

Complications

• severity frequently underestimated
• may progress to osteomyekitis, tenosynovitis or septic arthritis

Management

• consult hand surgeon
• treat as human bite
• consider hospitalization

More general terms

• hand laceration