|
Year |
2002 |
|---|---|
|
Question Number |
121. |
|
Category |
Hand |
Question
Figures 27a and 27b show the clinical photograph and radiograph of a 22-year-old man who was involved in an altercation in a bar 2 hours ago. Examination reveals that he has full active extension of all fingers and can make a fist with minimal pain. Management should consist of
1. IV antibiotics, splinting, and observation.
2. IV antibiotics and immediate debridement in the operating room.
3. local wound care and delayed fixation of the metacarpal head fracture.
4. irrigation of the wound in the emergency department, oral antibiotics, and immediate active range-of-motion exercises.
5. insertion of an indwelling joint catheter with serial infusion of antibiotic fluids.
Figures
Answer (click for answer)
Preferred response: #2
It seems this one is asked every year in multiple ways. The image depicts an dorsal hand laceration over an MCP joint, presumably caused by contact with the opponents mouth during a fist-fight. The answer is always the same—I/D, tetnus, and antibiotics. For animal bites, think Pasteurella multicida. For human oral flora, Eikenella corrodens must be covered, and unasyn IV or augmentin po will kill both. Doxycycline may be substituted for those PCN allergic.
Reference: Torstrick, RF. Chapter 7: Infections, in Hand Secrets, eds. Jebson and Kasdan, Hanley & Belfus, Philadelphia, 1998,pp. 35-39.