• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

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
OrthopedicsTraumaVisual EM
No ratings yet.

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 4th digit. On exam, the patient had a 1 cm laceration to his right 4th 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 4th 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.2 This 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.4  Ruptures involving <50% of tendon width should be placed in a volar extension splint, whereas ruptures involving >50% of tendon width should be sutured.3 Injuries to Zones II-IV and Zone VI may be repaired in the emergency department.4 However, 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:

  1. de Jong JP, Nguyen J, Sonnema A, Nguyen E, Amadio P, Moran S. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clin Orthop Surg.2014;6(2):196-202.doi: 10.4055/cios.2014.6.2.196
  2. Newport M L. Extensor tendon injuries in the hand. J Am Acad Orthop Surg. 1997; 5:59-66.
  3. 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
  4. Bowen W, Slaven E. Evidence-based management of acute hand injuries in the emergency department. Emerg Med Pract. 2014;16(12):1-24.
  5. Katzman B, Klein D, Mesa J, Geller J, Caligiuri D. Immobilization of the mallet finger. Effects on the extensor tendon. J Hand Surg Br. 1999;24(1):80-84.
  6. Shewring DJ, Trickett RW, Subrmanian KN, Hnyda R. The management of clenched fist ‘fight bite’ injuries of the hand.  J Hand Surg Eur Vol. 2015; 40(8): 819-24.  doi: 1177/1753193415576249
Icon

Fight Bite with Tendon Laceration - Case Report

1 file(s) 810 KB
Download
Icon

Fight Bite with Tendon Injury - Images

1 file(s) 2.6 MB
Download
Issue 3:3PhotographUltrasound

Reviews:

No ratings yet.

Please rate this





Recurrent Sigmoid Volvulus in a Young Female

14 Jul, 18

The Role of Chest X-Ray and Bedside Ultrasound in...

14 Jul, 18
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.