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    Treatment of clenched fist injuries is complicated by several factors. One factor is the anatomical structure of the human hand, which contains many small closed spaces that make it easy for infection to spread and persist. Another is the number of disease-causing bacteria transmitted by human bites; at least 42 different species have been identified. In addition, CFIs typically do not receive immediate treatment because the patient is concerned about legal consequences. The longer the delay, the higher the chances of infection and permanent damage to the hand. Patients who wait longer than 24 hours to seek treatment or have signs of infection or damage to the tendon, joint capsule, or bones are usually referred immediately to a doctor who specializes in hand surgery.

    The first step in treatment of clenched fist injury is irrigation, a procedure by which the wound is flushed with a stream of water under high pressure or with an antiseptic solution. Incision and drainage of the wound (I&D) may be required as well as debridement, the surgical removal of dead tissue and foreign objects from a wound. Careful examination of the depth of the wound is essential to proper treatment. The surgeon may need to enlarge the sides of the wound in order to make an accurate evaluation. The patient will be asked to move the affected joint through its full range of motion so that the surgeon can determine whether the tendon or joint capsule has been damaged. Following these procedures, the surgeon will pack the wound and put the hand in a splint. Bite wounds are never sutured (sewn shut) because of the possibility of enclosing bacteria inside the injury. After 24 hours, the packing will be removed and the hand reexamined for signs of infection.

    If the wound has become infected, the patient is usually hospitalized and given parenteral (injectable) antibiotics. The wound is irrigated and examined to determine the extent of the injury. Cultures are taken for both aerobic (requiring air or oxygen to live) and anaerobic (not requiring air or oxygen) species of bacteria. The cultures should be taken from areas deep in the wound rather than from the surface for greater accuracy. Tetanus toxoid should be given if the patient has not been immunized within the last 10 years. The patient should also receive treatment and follow-up for the rare possibility of HIV and hepatitis transmission. Although no well-documented cases of HIV transmission by human bites exist as of 2001, the potential for transmission by this route is still present.

    Infected clenched fist injuries usually contain several disease-causing bacteria, the most common being Streptococcus pyogenes, Staphylococcus aureus, Bacteroides sp., Peptostreptococcus sp., and Eikenella corrodens. Broad-spectrum antibiotics are usually given. Uninfected and relatively superficial CFIs may be treated with oral penicillin plus dicloxacillin or Augmentin. For infected CFIs, parenteral penicillin G is usually given together with nafcillin or cefuroxime. CFIs infected by drug-resistant strains of S. aureus may require treatment with vancomycin. While some human bite wounds don’t require routine use of antibiotics, a 2004 confirmed that puncture wounds, deeper lacerations and bites to the hand all have high infection rates which may be lowered by preventive use of antibiotics.

    Source: The Gale Group. Gale Encyclopedia of Medicine, 3rd ed.";

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