A laceration on the hand sustained from a punch is commonly called a fight bite and is typically infected with which organism; what is the recommended initial management?

• A. Fight bite from a punching injury caused by Eikenella corrodens; requires operating room irrigation.
• B. Staphylococcus aureus cellulitis treated with oral antibiotics only.
• C. Tetanus-related infection; administer tetanus booster.
• D. Herpetic infection; treat with antivirals.

Answer: (A)

Fight bites introduce oral bacteria into the hand, with Eikenella corrodens being the classic organism involved. The hand’s anatomy—with tight spaces around joints and tendon sheaths—allows infection to spread quickly, risking septic arthritis, tenosynovitis, or osteomyelitis even if a small skin wound seems minor. Because of this, the priority is urgent surgical irrigation and debridement in the operating room to thoroughly cleanse the wound, remove contaminated tissue, and assess for deep involvement. Start broad-spectrum antibiotics that cover oral flora (including Eikenella) promptly, and address tetanus prophylaxis as indicated. This approach targets the infection at its source and prevents progression, which is why it is the best initial management.