Human bites of the hand: the Tasmanian experience.

INTRODUCTION

The purpose of the present paper is to provide geographically representative information on the presentation, treatment and complications of human bites of the hand in Australia.

METHODS

A 5-year retrospective study was undertaken of patients treated at Royal Hobart Hospital for human bites of the hand. The variables evaluated included age, sex, hand involvement, anatomical distribution, presentation, operative findings, bacteriology, antibiotic use, X-ray findings, complications and compliance.

RESULTS

Thirty-five patients had human bites to the hand. All were male with a median age of 24 years. Most were clenched fist injuries with the middle metacarpophalyngeal joint being the most prone to injury. Patients presenting early had a high incidence of open joints and fractures but spent less time in hospital than late presenters, almost all who had infection complications. Compliance with treatment was found to be a major problem. Serious hand infections were not observed.

CONCLUSION

The treatment of human bites must be early, correct and comprehensive. The appropriate treatment is surgical exploration with debridement and lavage, appropriate antibiotic administration, hand elevation and initial immobilization. Poor compliance of patients in the present study was demonstrated by a high incidence of late presentation, self-discharge from hospital and loss to follow up, making assessment of outcomes difficult. Despite this there is an absence of serious hand infections reported in the literature and this may be due to the administration of antibiotics prior to referral.