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I read with interest the article and discussion on human bite
injuries by Henry et al (EMJ 2007; 24:455-458). I would like to make
reference to the particular importance of irrigation and debridement of
any such wound involving dental flora, as well as the high index of
suspicion required in an often unreliable cohort of patients.
We recently had a patient present to our department with a...
We recently had a patient present to our department with a delayed
presentation (two weeks) of a metacarpal injury to his dominant hand
following a dental-related closed fist injury. He had a fluctuant swelling
over his third metacarpal head and an extensor lag of 10-15 degrees
(although, surprisingly, otherwise normal range of movement). Clinical
suspicion resulted in exploration in theatre and evidence of both extensor
tendon damage and a significant septic arthritis. This resulted in
thorough intra-articular and soft tissue irrigation as well as a degree of
Unfortunately, as an oversight, antibiotics were prescribed but not
dispensed and the patient was discharged without formal antimicrobials. On
reviewing the gentleman on day three he was making excellent clinical
progress and the decision was made to closely monitor and continue to
withhold antibiotics. He continued to make good clinical progress and made
an excellent recovery with full functional capacity.
Despite a significant septic arthritis this patient required no
antimicrobials and highlights once again the importance of meticulous
irrigation and debridement in the management of these cases.