Surgical Management of Human Bite Injuries to the Hand

Abstract

Human bite injuries to the hand are high-risk wounds because of their polymicrobial contamination, proximity to joints and tendons, and tendency to appear deceptively minor at presentation. Clenched-fist injuries, commonly known as “fight bites,” are particularly dangerous because they frequently occur over the metacarpophalangeal joints and may penetrate the extensor tendon, joint capsule, cartilage, or bone. Delayed diagnosis or inadequate initial treatment can lead to cellulitis, abscess, septic arthritis, tenosynovitis, osteomyelitis, stiffness, amputation, and permanent functional loss. Surgical management requires early recognition, copious irrigation, careful exploration, timely debridement, drainage when indicated, broad-spectrum antibiotic therapy, and delayed closure in contaminated or infected wounds. Antibiotics alone are insufficient when deep infection or joint involvement is present. Early treatment pathways, including emergency department washout, ambulatory or day-case surgery, and rapid access to operative debridement, may reduce hospital stay and cost without compromising outcomes in selected patients. This review summarizes the microbiology, clinical assessment, surgical indications, operative principles, antibiotic strategy, and outcome considerations in human bite injuries to the hand.