Fight Bite with Tendon Laceration

doi:https://doi.org/10.21980/J8MP7Q

Fight Bite with Tendon Laceration

Michelle Chang, MD^*, Grant Wei, MD^*, Christopher J Bryczkowski, MD^*, Sha Yan, DO^* and Chirag N Shah, MD^*

^*Rutgers – Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, NJ

Correspondence should be addressed to Chirag Shah, MD at shahcn@rwjms.rutgers.edu

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3

Orthopedics Trauma Visual EM

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History of present illness:

A 57-year-old male presented 24 hours after punching another individual in the mouth and injuring his right hand. He complained of pain and decreased range of motion in his 4^th digit. On exam, the patient had a 1 cm laceration to his right 4^th metacarpophalangeal joint with soft tissue swelling and limited extension of the digit against resistance.

Significant findings:

The video shows a water bath ultrasound of the right 4^th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image).

Discussion:

Hand extensor tendon injuries can be caused by laceration, trauma, or overuse.¹ Extensor tendon injuries are classified into eight zones.²This patient suffered a Zone V partial tendon injury, commonly termed a “fight bite.” Management of tendon injuries is dependent on: partial vs full, closed vs open, and injury location.^3,4 Closed tendon injuries require a volar extension splint with hand surgery follow-up within one week. Open tendon injuries involving >50% tendon width can be repaired in the emergency department, though some will require delayed repair.⁴Ruptures involving <50% of tendon width should be placed in a volar extension splint, whereas ruptures involving >50% of tendon width should be sutured.³Injuries to Zones II-IV and Zone VI may be repaired in the emergency department.⁴However, injuries to other zones, the thumb, open fractures, neurovascular compromise, grossly contaminated wounds, or immunocompromised patients should be referred to a hand surgeon.⁵“Fight bite”injuries should be treated with antibiotics and hand surgery consult for possible operative intervention.⁶

After a normal X-ray, a bedside water-bath ultrasound was performed, revealing a Zone V extensor tendon rupture. The patient received tetanus prophylaxis, IV antibiotics, was splinted and admitted to the hand surgery service for operative washout of the wound and delayed tendon repair.

Topics:

Water bath ultrasound, tendon laceration, extensor tendon injury, fight bite, hand injury, orthopedics.

References:

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Griffin M,Hindocha S, Jordan D, Saleh M, and Khan W. Management of extensor tendon injuries. The Open Orthopedics Journal. 2012; 6:36-42.doi: 2174/1874325001206010036
Bowen W, Slaven E. Evidence-based management of acute hand injuries in the emergency department. Emerg Med Pract. 2014;16(12):1-24.
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