Case study ( 2744 views as of September 20, 2019 )
Jaxon is a 13-year-old male who has had swelling to his right hand at the second and third knuckles over the last three days. He has small cuts over each, and yellow drainage from one of the wounds. He cannot fully close his fist due to the pain and swelling. His mother noticed just that morning when Jaxon had trouble closing his backpack before school, and when she questioned him, Jaxon reports that he tripped at school and 'fell on his fist'.
Jaxon should be seen by his primary care provider, and/or the emergency department. It is unusual to fall on a closed fit, so his mother and the adults caring for him should wonder about the truth of how Jaxon's injury was sustained. Injuries over the knuckles should always raise suspicion for a punch-related mechanism. Cuts over the knuckles due to contact with someone else's mouth are commonly referred to as a 'fight bite', and carry the same risks of secondary infection as a bite wound. Further, injury to the tendons and contamination of the joint or bones is a consideration. A fracture in the bones of the hands should be excluded as well.
Jaxon is also a minor, and if he has been in a fight, consideration of him being bullied, or being a bully, should be explored. Other injuries should be considered, as he may not be forthcoming about where he is hurt. Jaxon may benefit from excellent wound care, antibiotics, splinting/bracing and hand physiotherapy. He may also require some social and mental health support, including interventions at the school level.Author: Dr. Adam Lund