The Significance of Bone Abrasions in Fight Bite Injuries: Beware of the Osteochondral Defect.

Abstract

Sir, Fight bites are commonly seen in emergency departments worldwide and are referred to hand surgeons. Seemingly innocuous puncture wounds over the metacarpophalangeal (MCP) joint, left untreated, can rapidly progress to septic arthritis with a hot, erythematous, painful and swollen joint. Mismanagement results in disastrous outcomes and inevitable destruction of the joint. 1) As implied, fight bites are usually sustained through violent altercations. Patients are often unreliable historians due to poor recollection, reluctance to seemingly incriminate themselves, and an under appreciation that dental contact is relevant to their management. We recommend careful, tactful questioning using neutral terms by the first line clinician: “Could the wound have been caused by contact with another person’s teeth? We ask as such injuries can cause serious infections.”