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Last night I witnessed a bar fight (my first ever). I tried to get the guy (a friend) who did the punching (to protect me) to go to the hospital for what looked like a bad wound on his knuckles. He must have cut his hand on the other guy's teeth. He refused to go and today I'm worried about broken bones, infection, I don't know what! What do you advise?
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Acute fight bites that result in broken skin from contact with someone else's tooth/teeth have a high potential for infection and more dire consequences. It is advised that he get medical evaluation and treatment as soon as possible.
Even a small skin opening from such an injury can allow bacteria to enter the body. The joint can become infected to the point that finger amputation is the end-result. Not all complications from infection following an acute fight bite of the hand are as drastic as finger amputation. But loss of motion, decreased grip strength, tenosynovitis, osteomyelitis, and septic arthritis occur in up to one-third of all cases. With up to 50 different types of bacteria in the human mouth, the concern for infection is very real.
Antibiotics are given prophylactically to prevent infection in almost all cases. The only two exceptions are: 1) patients with minimal superficial wounds (skin is not broken) and 2) those individuals who come for care 72 hours or more after the injury and have no signs of infection. The physician may also surgically debride the wound (open the hand down to the bone/joint and clean out any microbes present).
Without knowing what may happen in those early hours after the contact with someone's tooth, a wide-spectrum antibiotic is given. Anyone with clinical signs of infection (fever; red, swollen, tender or painful skin/joint) should receive additional medications including intravenous antibiotics.
The biggest concern is for patients who do not seek care immediately and wait up to a week before getting treatment. The risk of amputation from infection increases dramatically with longer delays between injury and care. Patients whose tetanus shots are out-of-date and who have not had hepatitis vaccinations (or for whom hepatitis B status is unknown) will require additional treatment.
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