Domestic Horse Bite: An Unusual Etiology of Crush Injury of the Fourth Finger-How to Manage?
Abstract: Almost 2% of all emergency admissions involve an animal bite. While horses bite humans very rarely, their bites are mostly associated with fatalities. Herein, we report the case of a 23-year old bitten by a domestic horse causing a crush injury to his fourth finger with fracture dislocation of the proximal interphalangeal joint. The patient benefited upon arrival at the emergency department from copious irrigation with saline serum, tetanus toxoid, postexposure rabies vaccination, and prophylactic antibiotic therapy. In the operating room, surgical exploration found the ulnar digital pedicle sectioned, the flexor and extensor tendons sectioned and shredded, and the skin shredded. An excisional debridement of devitalized tissue with copious irrigation was performed, and the finger regularized at the level of traumatic amputation with tendon striping followed by coverage of the bone by the radial digital flap with careful clinical and biological monitoring after the surgery. At the last follow-up, the patient revealed no sign of infection, and he returned to his usual activities and has been discharged from care. This wound management, based on a careful examination, a meticulous debridement, and an efficient cleaning with early and targeted antibiotic therapy, might promote good results and avoid dangerous complications.
Publication Date: 2019-01-30 PubMed ID: 30838145PubMed Central: PMC6374822DOI: 10.1155/2019/2156269Google Scholar: Lookup
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Summary
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The research paper discusses a unique case of a 23-year-old patient who suffered a crush injury to the fourth finger, due to a bite from a domestic horse, and the subsequent steps taken for the management of the wound and recovery of the patient.
Background and Purpose of Study
- The paper elaborates on an unusual case dealing with a severe horse bite which isn’t a common occurrence. Though rare, horse bites often lead to serious, sometimes fatal injuries. The main motive behind the paper is to discuss the unique injury and how it was managed.
Details of the Injury
- A 23-year old patient arrived at the hospital with a crush injury to his fourth finger. The injury was caused by a domestic horse bite which had resulted in a fracture dislocation of the proximal interphalangeal joint.
- The injury was critical as it involved sectioning of the ulnar digital pedicle, shredding of extensor and flexor tendons, along with skin shredding.
Initial Emergency Management
- On arrival at the emergency department, the patient’s wound was treated with copious irrigation using saline serum. This is essential to remove any debris and reduce the chance of possible contamination leading to infection.
- A tetanus toxoid was administered to prevent tetanus, a serious bacterial infection that can be caused by animal bites.
- Postexposure rabies vaccination was given, since there was a risk of rabies transmission through the horse bite.
- Prophylactic antibiotic therapy was started immediately to prevent any potential bacterial infection from setting in.
Surgical Intervention and Outcome
- During surgical exploration, the injury severity was fully assessed, including the state of tendons and skin surrounding the injury.
- An excisional debridement of devitalized tissue was performed. This surgical procedure involves the removal of damaged or infected tissue to promote wound healing and decrease the risk of infection.
- After debridement, copious irrigation was performed again and the finger was regularized at the level of traumatic amputation with tendon striping. The coverage of the bone was ensured by the radial digital flap.
- Post-operative care involved close clinical and biological monitoring. The patient showed no signs of infection at the last follow-up and resumed his usual activities. He was safely discharged from care, indicating successful wound management.
Key Takeaways
- The paper emphasizes the importance of careful examination, meticulous debridement, efficient cleaning, and early, targeted antibiotic therapy in managing this severe injury.
- The careful approach in managing the injury promoted good results and avoided dangerous complications, thus setting an example for the management of similar injuries in the future.
Cite This Article
APA
Elghoul N, Jalal Y, Bouya A, Zine A, Jaafar A.
(2019).
Domestic Horse Bite: An Unusual Etiology of Crush Injury of the Fourth Finger-How to Manage?
Case Rep Infect Dis, 2019, 2156269.
https://doi.org/10.1155/2019/2156269 Publication
Researcher Affiliations
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), BP 10100 Rabat, Morocco.
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), BP 10100 Rabat, Morocco.
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), BP 10100 Rabat, Morocco.
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), BP 10100 Rabat, Morocco.
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), BP 10100 Rabat, Morocco.
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