HAND INFECTIONS SECONDARY TO FISH BONE INJURIES

Hand injuries associated with fish bones and fin spines are not common but can cause morbidity out of proportion to the original injury. Thi s is because such injuries often leave residual fragments of foreign o rganic matter in the tissues, leading to troublesome secondary infecti ons. This report details 1 year's experience with nine hand infections after fish bone injury in a busy regional hand surgery referral centr e. There were five males and four females with an average age of 45 ye ars. Radiographs taken on presentation in five patients revealed a rad iolucent foreign body in only two patients. Two patients presented wit h a flexor tendon sheath infection, three with a pulp space infection, one with infection of the hypothenar space, one with a subungual infe ction, one with cellulitis of the dorsum of the hand and one with an a bscess on the dorsum of the hand. Antibiotics were prescribed for six patients and all patients except the one with cellulitis of his hand u nderwent surgical debridement. A single surgical procedure was adequat e in five patients. One patient with a hypothenar space infection only had the foreign body removed during the third surgical debridement. T he two patients with flexor tendon sheath infections required ray ampu tation. Fish bones cause a number of different infections in the hand. A foreign body should always be sought even if not present on the rad iograph. Antibiotic selection should be tailored to eradicate the caus ative organism.