FRCS Oral Examination Abbreviated: Fight Bite Case Mastery
Key Takeaway
Learn more about FRCS Oral Examination Abbreviated: Fight Bite Case Mastery and how to manage it. A fight bite is a serious hand injury from human teeth, posing a high infection risk due to oral flora—microbes often assessed during an **oral examination abbreviated** for dental health. These injuries demand immediate emergency assessment for septic arthritis, tendon damage, and fractures, as they constitute a surgical emergency often requiring radiographs.
A 32-year-old male presents to the clinic 10 days after a "fight bite" to his right dominant hand. He was initially seen at a local urgent care centre, where the wound was sutured and he was discharged with oral antibiotics. He now complains of significant pain, stiffness, and foul-smelling discharge from the wound. Clinical examination reveals erythema, marked swelling, and purulence at the 3rd MCP joint.
Candidate: "This patient likely has septic arthritis of the 3rd MCP joint due to the initial misdiagnosis and improper closure of a high-risk human bite. I would remove the sutures, perform an urgent washout, start IV antibiotics, and likely need an MRI to rule out osteomyelitis."
Candidates often focus solely on the antibiotics without acknowledging the orthopedic catastrophe created by primary closure. They fail to mention the need for an emergent trip to the operating theatre, or worse, suggest 'monitoring' the infection. Failing to address the potential for underlying tooth fragment involvement or osteomyelitis is a critical oversight.
The candidate must articulate a structured approach: 1. Immediate Assessment: Confirm neurovascular status and assess the extent of the infection (e.g., tenosynovitis vs. septic arthritis). 2. Investigations: Plain radiographs to rule out fracture/foreign body; blood markers (CRP/WBC). 3. Definitive Management: State clearly that "this is a surgical emergency." Describe the need for formal I&D, synovectomy, and potentially leaving the wound open (delayed primary closure). 4. Microbiology: Mention the specific need to cover for Eikenella corrodens with empiric IV antibiotics (e.g., co-amoxiclav) and confirm the importance of deep intra-operative cultures. 5. Complications: Acknowledge the risk of chronic osteomyelitis and the need for early hand therapy to prevent stiffness.
