Tag Archives: Fight Bite

“Boxer’s Fracture” and “Fight Bite”

Quick Hits:

Fifth Metacarpal Neck fracture (aka Boxer’s fracture)

  • usual mechanism of injury with metacarpal neck fractures involves direct trauma to a clenched fist
  • Dorsum of the hand is swollen and bony tenderness is found over the fractured metacarpal.
  • Three views of the hand (anteroposterior (AP), lateral, and oblique) adequately display metacarpal neck fractures
  • Angulation occurs in an apex dorsal direction due to the pull of interosseous muscles.
  • Functional bracing with custom or off-the shelf orthoses are effective and commonly used in the management of metacarpal neck fractures
  • Lacerations at the site of trauma (“fight bites”) are common and predispose to infection.

Closed Fist infection (aka Fight Bite)

  • present with small wounds overlying the metacarpophalangeal joints (skin breaks over the knuckle when punching face and hitting teeth) – most comonly third, fourth, and/or fifth MCP
  • highly prone to infection given the proximity of the skin over the knuckles to the joint capsule
  • Clinical manifestations of bite wound infections may include fever, erythema, swelling, tenderness, purulent drainage and lymphangitis
  • Deep bite wounds near joints warrant AP and lateral plain radiographs to evaluate for disruption of bone or joints and evidence of foreign bodies
  • Treatment:
    • no signs of infection = empiric Augmentin (amoxicillin-clauvanate) 875/125mg PO BID x5days
    • signs of infection = empiric Unasyn (ampicillin-sulbactam) 1.5-3g IV q6
    • Tetanus and rabies prophylaxis should be provided as indicated

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