All human bite wounds are potentially serious and at risk of catastrophic complications. But the particular type called fight bite is very common and often treated as minor injury, because underestimation of the lesion without the recognition that the joint capsule, extensor tendon or deep fascial may be damaged and contaminated with oral bacteria. Significant complications may arise after inappropriate initial treatment or late presentation. We present a case and a review of clinical presentation, diagnostic techniques and management options that may be applied by emergency doctors. Introduction The objective of this paper is to show a case of clenched fist and the importance in emergency of a common pathology that can be underestimated with catastrophic consequences.The lesion in much more serious than it initially appears. The patient hit another individual in the mouth region with the fist. This blunt impact on the patient produces soft tissue and bone injury. The teeth of the victim generate a small (3-5 mm) laceration over the dorsal metacarpophalangeal (MCP) joint and appears innocuous to the patient and the unwary doctor.These injuries create an inoculation of oral bacteria in a close space, and can involve soft tissue, joint space and tendon sheath. Due to prompt resolution, is very frequent that this kind of lesion to be underestimated by the patient, arising complication affecting the local functionality and systemic damage. Case Report 65 years old male, arrived to consult after 5 days of a street fight with tachycardia, hypotension, fever, confuse (Glasgow scale 13/15). At ED, clinical observation secretion through a small injury on the dorsal aspect of the proximal phalanx of 3 finger in left hand; increase of local temperature, slow capillary reflux, edema on the forearm, flictenas on dorsum of hand and forearm, exacerbated pain at finger mobilization, and decrease in distal sensibility (median nerve territory), no crepitation was detected. The patient report that was assisted in an other institution after the injury and discarted bone fractures with x-rays and ordered to use ice and pervinox cleaning for 2 days.
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