A dtt e)ullufi9tufluu Original Article

A d.i4 -lul:ryrurulafl?::rirJ:vmYndRr:fl orro mil oolRU lotr9{ aBRnuno

Human Bite Iniury of the Hand in Sawanpracharak Hospital

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Prathan Oprasertsawat M.D.

Department of Orthopaedics

Sawanpracharak Hospital

Nakhon Sawan

Sawanpracharak Medical ]ournal

VoLr Noz May-August zooa

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Abstract

Obiective

Setting

Design

Subjects

Method

Results

Conclusion

Key words

To study the prevalence of human bite of the hand, and type ofinjury severity, treatment and result of treatment.

Sawanpracharak Hospital.

Descriptive study

27 patients presented with hand injury by human bite between2003-2007.

This study was performed by reviewing of medical records with focuson site of injury, duration from injury until treatment, microbiological

culture, antibiotic intervention, operative findings and compliance.

All27 patients were male with mean age of 2g years. Most of injury

involved 3d Metacapo-pharyngear joint. Time interval between injury

and presentation was 2 days. patients in an early treatment group(with in 48 hours) were presented with fracture (2s.0%); further morepatients in a delay treatment group were present with infectivecomplications (85.7%). 4o.7o/" of patients on post operative appointment

attend follow-up session.

Hand injuries from human bites are complicated by hand infections

and must be treated adequately. optimal treatrnent and follow up is often

difficult to achieve due to high rates of non compliance.

Human bite injury, Clench fist injury

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fld S oriud 2 fl.n.-6.n. 2551 Humm Bite Injury of rhe Hmd in Sawmprachuak Hospital 883

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dr.:ornonduu'l.:Ltrr.r mta'lfi syringe 20 'lnf,fior uasrinm:rod'r nr#rryrmti(inr*r"hlq q "_{- '-'-'_A AA J oqn o

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ulpruzua Oa6l{aEi1\:fiaa t-z fisr: urayrflpr drrufiatunr:inurrurn{u

lonmtol{o'i1. Callaham M. Controversies in antibiotic choices for bite wounds. Ann Emerg Med

1988; 17: 1321-30.

2. McGrath MH. Infections of the hand. ln: McCarthy MC, ed.Plastic Surgery, vol 8:

The hand. PA: WB Saunders Company; 1990: 5534-5.

3. Smith P. Acute inflammatory conditions. ln: Lister's the hand:diagnosis, indications,

4'h ed. PA: Churchill Livingstone; 2OO2: 319-21.

4. Zubowics VN, Gravier M. Management of early human bites of the hand: aprospective randomized study. Plast Reconstr Surg 1991; g: 111-4.

5. Tonta K, Kimble FW. Human bites of the hand: the Tasmanian experience. ANZ

J Surg 2001; 71: 467-71.

itd s ariud 2 fl.Fr.-d.n. 25s1

nr:6nrdofi fi orrnurnunaqnnutinlul:.rrururom::rirl:;srinfHumm Bite hjury of The Hmd in Sawanprrchrak Hospital 887

6. Dreyfuss UY, Singer M. Human bites of the hand: a study of 106 patients. J

Hand Surg (Am) 1985; 10: 884-9.

7. Marr JS, Beck AM, Lugo JA. An epidemiological study of the human bite. Public

Health Rep 1979; 94: 514-21.

B. Phair lC, Quinton DN. Clenched fist human bite injuries. J Hand Surg (Br) 1989;

14:' 86-7.

9. Gonzalez MH, Papeirski P, Hall RF. Osteomyelitis of the hand after a human

bite. J Hand Surg Am 1982; 7: 388-94.

10. Broder J, Jerrard D, Olshaker J, Witting M. Low risk of infection in selected human

bites treated without antibiotics. Am J Emerg Med 2004; 22: 1O-3.

11.Revis Jr. DR. Human bite infections [cited 13 Mar 2008] 2OO4. Available at:

http://www.emed ici ne.com/med/topicl 033. htm.

12.Guba AM, Mulliken JB, Hoopes JE. The selection of antibiotics for human bites

of the hand. Plast Reconstruct Surg 1975; 56: 538-41.

13. Lindsey D, Christopher M, Hollenbach J. Natural course of the human bite

wound J Trauma 1987; 27:45-8.

l4.Goldstein EJ. Bite wounds and infection. Clin lnfect Dis 1992; 14:633-8.

l5.Patzakis MJ, Wilkins J, Bassett RL. Surgical findings in clenchedfist injuries. Clin

Orthop 987; 220: 237-40.

16.Mennen U, Howells CJ. Human bite infections of the hand.J Hand Surg'1991;

16: 431-5.

17. Talan DA, Abrahamian FM, Moran GJ. Clinical presentation and bacteriologic

analysis of infected human bites in patients presenting to emergency departments.

Clin lnfec Dis 2003; 37: 1481-9'

18. Basadre JO, Parry SW. lndications for surgical debridement in 125 human bites

to the hand. Arch. Surg. 1991:' 126:65-7.

19.Kelly lP, Cunney RJ, Smyth EG, Colville J. The management of human bite

injuries of the hand. lnjury 1996; 27: 481-4-

20. Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian

bites. Acad Emerg Med 2000; 7: 157-61-

21. perron AD, Miller MD, Brady WJ. Orthopedic pitfalls in the ED: fight bite. Am J

Emerg Med 2002; 20: 1'14-7.

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22. Malinowski RW, Strate RG, Perry FF. The management of human bite injuries

of the hand. J Trauma 1979; 19: 655-9.

23. Chadaev AP, Jukhtin Vl, Butkevich AT. Treatment of infected clench-fist

human bite wounds in the area of the metacarpophalangeal joints. J Hand Surg

(Am.) 1996; 21: 299-303.

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