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Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review

  • Review Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries.

Methods

MEDLINE, Scopus and CINAHL were used as the literature sources.

Inclusion criteria

Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication.

Exclusion criteria

Case studies, case series and review articles were not included.

Results

After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8–8 days of admission and 1.3–2.7 debridements each.

Conclusion

Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs.

Systematic review registration number

PROSPERO CRD42016029949 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949).

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References

  1. Kelly IP, Cunney RJ, Smyth EG, Colville J. The management of human bite injuries of the hand. Injury. 1996;27(7):481–4.

    Article  CAS  PubMed  Google Scholar 

  2. Basadre JO, Parry SW. Indications for surgical débridement in 125 human bites to the hand. AMA Arch Surg. 1991;126(1):65–7.

    Article  CAS  PubMed  Google Scholar 

  3. Goon P, Mahmoud M, Rajaratnam V. Hand trauma pitfalls: a retrospective study of fight bites. Eur J Trauma Emerg Surg. 2008;34(2):135–40.

    Article  PubMed  Google Scholar 

  4. Marr JS, Beck AM, Lugo JA. An epidemiological study of the human bite. Public Health Rep. 1979;94:514–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Patzakis MJ, Wilkins J, Bassett RL. Surgical findings in clenched-fist injuries. Clin Orthop Relat Res. 1987;220:237–40.

    Google Scholar 

  6. Goldstein EJC. Bite wounds and infection. Clin Infect Dis. 1992;14(3):633–40.

    Article  CAS  PubMed  Google Scholar 

  7. Mason ML, Koch SL. Human bite infections of the hand. Surg Gynec Obst. 1930;51:591.

    Google Scholar 

  8. Smith P. Acute inflammatory conditions. In: Smith P, editor. Lister’s the hand: diagnosis and indications. 4th ed. London: Harcourt Publishers; 2002. p. 319–21.

    Google Scholar 

  9. Mennen U, Howells CJ. Human fight-bite injuries of the hand. A study of 100 cases within 18 months. J Hand Surg Eur Vol. 1991;16(4):431–5.

    Article  CAS  Google Scholar 

  10. Loman M, Bryceson W, Fraser D. The epidemiology of tooth knuckle injury (TKI) in far north Queensland. In: Australian Orthopaedic Association Annual Scientific Meeting 2014; Melbourne; Australian Orthopaedics Association; 13/10/2014.

  11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Article  PubMed  Google Scholar 

  12. Smith H, Hartman H, Gunnarsson R, Loveridge J. Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review. PROSPERO: International prospective register of systematic reviews 2016. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949. Accessed 15 May 2016.

  13. Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Critical review form—quantitative studies. McMaster University: occupational therapy evidence-based practice research group. 1998.

  14. Hall BI. Punch injuries to the hand in far north Queensland. Med J Aust. 1992;156(11):806–7.

    CAS  PubMed  Google Scholar 

  15. Shewring DJ, Trickett RW, Subramanian KN, Hnyda R. The management of clenched fist ‘fight bite’ injuries of the hand. J Hand Surg Eur Vol. 2015;40(8):819–24.

    Article  CAS  PubMed  Google Scholar 

  16. Decker MD. Eikenella corrodens. Infect Control. 1986;7:36–41.

    Article  CAS  PubMed  Google Scholar 

  17. Schmidt DR, Heckman JD. Eikenella corrodens in human bite infections of the hand. J Trauma. 1983;23(6):478–82.

    Article  CAS  PubMed  Google Scholar 

  18. Dreyfuss UY, Singer M. Human bites of the hand: a study of one hundred six patients. J Hand Surg Am. 1985;10(6 I):884–9.

    Article  CAS  PubMed  Google Scholar 

  19. Oprasertsawat P. Human Bite Injuries of the Hand at Sawanpracharak Hospital: 10 years of experience. Thai J Orthop Surg. 2010;34(3–4):30–6.

    Google Scholar 

  20. Mann RJ, Hoffeld TA. Baring Farmer C. Human bites of the hand: twenty years of experience. J Hand Surg Am. 1977;2(2):97–104.

    Article  CAS  PubMed  Google Scholar 

  21. Chadaev AP, Jukhtin VI, Butkevich AT, Emkuzhev VM. Treatment of infected clench-fist human bite wounds in the area of metacarpophalangeal joints. J Hand Surg Am. 1996;21(2):299–303.

    Article  CAS  PubMed  Google Scholar 

  22. Shields C, Patzakis MJ, Meyers MH, Paul Harvey J. Hand infections secondary to human bites. J Trauma. 1975;15(3):235–6.

    Article  CAS  PubMed  Google Scholar 

  23. Bilos ZJ, Kucharchuk AK, Metzger W. Eikenella corrodens in human bites. Clin Orthop Rel Res. 1978;134:320–4.

    Google Scholar 

  24. Phair IC, Quinton DN. Clenched fist human bite injuries. J Hand Surg Br. 1989;14(1):86–7.

    Article  CAS  PubMed  Google Scholar 

  25. Tonta K, Kimble FW. Human bites of the hand: the Tasmanian experience. ANZ J Surg. 2001;71(8):467–71.

    Article  CAS  PubMed  Google Scholar 

  26. Goldstein EJ, Barones MF, Miller TA. Eikenella corrodens in hand infections. J Hand Surg Am. 1983;8(5):563–7.

    Article  CAS  PubMed  Google Scholar 

  27. Jalil A, Barlaan PI, Fung BK, Ip JW. Hand infection in diabetic patients. Hand Surg. 2011;16(3):307–12.

    Article  PubMed  Google Scholar 

  28. Glass KD. Factors related to the resolution of treated hand infections. J Hand Surg Am. 1982;7(4):388–94.

    Article  CAS  PubMed  Google Scholar 

  29. Macintosh DJ, Pearson JB. Patterns of injury in indigenous Australians admitted to Cairns Base Hospital. Aust J Rural Health. 2003;11(2):99–106.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

    H. R. Smith & H. Hartman

  2. Department of Orthopaedic Surgery, Cairns Hospital, Cairns, QLD, Australia

    J. Loveridge

  3. Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia

    R. Gunnarsson

Authors
  1. H. R. Smith
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  2. H. Hartman
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  3. J. Loveridge
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  4. R. Gunnarsson
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Corresponding author

Correspondence to H. R. Smith.

Ethics declarations

Conflict of interest

Hamish Smith, Hannah Hartman, Jeremy Loveridge and Ronny Gunnarsson declare that they have no conflict of interest.

Funding disclosure summary

This work was supported by the College of Medicine and Dentistry, James Cook University, Queensland, Australia, with a research grant awarded to Hamish Smith.

Ethical approval

The study described does not contain studies with human or animals performed by any of the authors.

Appendix: Search strategies

Appendix: Search strategies

MEDLINE search strategy (OvidSP)

  1. 1.

    human bites.mp. or exp bites, human/

  2. 2.

    (fight bite or tooth knuckle injur* or clenched fist injur* or closed fist injur* or punch bite or fite bite).tw.

  3. 3.

    1 or 2

  4. 4.

    costs.mp. or exp cost and cost analysis/

  5. 5.

    debridement.mp. or exp debridement

  6. 6.

    washout*.mp.

  7. 7.

    therapeutic irrigation.mp. or exp therapeutic irrigation/

  8. 8.

    drainage.mp or exp drainage/

  9. 9.

    length of stay.mp. or exp length of stay/

  10. 10.

    complication*.mp.

  11. 11.

    exp hand injury/co (complications)

  12. 12.

    gangrene.mp. or exp gangrene/

  13. 13.

    osteomyelitis.mp. or exp osteomyelitis/

  14. 14.

    septic arthritis.mp. or exp arthritis, infectious/

  15. 15.

    stiff*.mp

  16. 16.

    range of motion.mp. or exp range of motion, articular/

  17. 17.

    chronic pain.mp. or exp chronic pain/

  18. 18.

    ankylosis.mp. or exp ankylosis/

  19. 19.

    amputation.mp. or exp amputation/

  20. 20.

    tenosynovitis.mp. or exp tenosynovitis/

  21. 21.

    treatment failure.mp. or exp treatment failure/

  22. 22.

    4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21/

  23. 23.

    3 and 22/.

Scopus search strategy

[(TITLE-ABS-KEY(“human bites”) OR TITLE-ABS-KEY(fight bite) OR TITLE-ABS-KEY(tooth knuckle injur*) OR TITLE-ABS-KEY(clenched fist injur*) OR TITLE-ABS-KEY(closed fist injur*) OR TITLE-ABS-KEY(punch bite) OR TITLE-ABS-KEY(fite bite))] AND [(TITLE-ABS-KEY(“cost and cost analysis”) OR TITLE-ABS-KEY(debridement*) OR TITLE-ABS-KEY(washout*) OR TITLE-ABS-KEY(“therapeutic irrigation*”) OR TITLE-ABS-KEY(drainage*) OR TITLE-ABS-KEY(“length of stay*”) OR TITLE-ABS-KEY(complication*) OR TITLE-ABS-KEY(gangrene*) OR TITLE-ABS-KEY(osteomyelitis) OR TITLE-ABS-KEY(“septic arthritis”) OR TITLE-ABS-KEY(stiff*) OR TITLE-ABS-KEY(“range of motion”) OR TITLE-ABS-KEY(“chronic pain”) OR TITLE-ABS-KEY(ankylosis) OR TITLE-ABS-KEY(amputation*) OR TITLE-ABS-KEY(tenosynovitis) OR TITLE-ABS-KEY(“treatment failure”))].

CINAHL search strategy

[human bites OR fight bite OR tooth knuckle injury OR closed fist injury OR clenched fist injury OR punch bite OR fite bite) AND (costs OR cost and cost analysis OR debridement OR washout* OR therapeutic irrigation OR drainage OR length of stay OR complication OR gangrene OR osteomyelitis OR septic arthritis OR stiffness OR range of motion OR chronic pain OR ankylosis OR amputation OR tenosynovitis OR treatment failure].

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Smith, H.R., Hartman, H., Loveridge, J. et al. Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review. Eur J Trauma Emerg Surg 42, 701–710 (2016). https://doi.org/10.1007/s00068-016-0701-6

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  • DOI: https://doi.org/10.1007/s00068-016-0701-6

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