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Year |
2001 |
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Question Number |
76. |
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Category |
Select |
Question
A 22-year-old man is seen in the emergency department after sustaining injuries in a fight 12 hours ago. Examination reveals swelling and local cellulitis over the dorsum of his right hand and a small draining puncture wound over the metacarpophalangeal joint. He is afebrile. A clinical photograph is shown in Figure 18. Radiographs show no fractures. Management should consist of
1- discharge home with sterile dressing changes, antibiotics for ten days, and a follow-up examination in 48 hours.
2- Povidone-iodine soaks and IV administration of 2 g of cefazolin in the emergency department, discharge home with daily povidone-iodine soaks, and antibiotics for 10 days.
3- Hospital admission for elevation and IV antibiotics.
4- Hospital admission, IV antibiotics, and hyperbaric oxygen treatment two times a day for 4 to 6 days.
5- Hospital admission, exploration, irrigation and debridement, and IV antibiotics.
Figures
Answer (click for answer)
Answer- 5 The key to this question is recognizing the injury is a human bite and assumed to have intraarticular extension. Now that it is draining it is assumed to be an infected intraarticular human bite. You will never be wrong to admit the patient, explore the wound and give IV antibiotics. Splitting and elevating a hand infection is also considered standard treatment. N.B. The love to ask about the bacteria associated with human, dog and cat bites—Humans-most common organism is Strep. viradans, S. aureus with Eikenella corrodens accounting for 7-29% of infections, antibiotic of choice Augmentin or ampicillin-sulbactam. Dog and cats’ most common organism is alpha-hemolytic Streptococcus(46%), Paturella multicida(26%), S. aureus(13%), anaerobes(41%) treatment of choice is the same except for DF-2 infections which require penicillin.
Reference: Topper SM, Hand and Microsurgery in Miller MD(ed): Review of Orthopaedics. Philadelphia, PA, WB Saunders, 2000 pp. 318.