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“Fight-Bite”: Not Just a Hand Problem

Cook, CPT Jay B. MD*; Knox, MAJ Jeffrey B. MD*; Wimberly, Robert L. MD; Ellis, Henry B. MD; Riccio, Anthony I. MD

Journal of Pediatric Orthopaedics: September 2014 - Volume 34 - Issue 6 - p 647–649
doi: 10.1097/BPO.0000000000000155

Human bite wounds around the knee are rarely seen, yet may require the same urgent attention as a fight bite to the hand. Two cases of polymicrobial septic arthritis of the knee secondary to a human bite wound are described. In both the cases, the diagnosis of the septic arthritis was delayed because the intra-articular wound was unrecognized. The injuries were initially deemed superficial and managed with local wound care. In each case, the knee was flexed at the time of injury and the quadriceps tendon was penetrated by a tooth which inoculated the knee joint. Septic arthritis of the knee presented, in both cases, 72 hours after the injury. These infections proved challenging to treat and required multiple surgeries and prolonged antibiotic therapy. The “fight bite” phenomenon of the hand is widely recognized and the same phenomenon can occur at the knee.

*Tripler Army Medical Center, Orthopedic Surgery Service, Honolulu, HI

Department of Orthopedics, Texas Scottish Rite Hospital for Children and Children’s Medical Center, Dallas, TX

The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

The authors declare no conflicts of interest.

Reprints: Anthony I. Riccio, MD, Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children’s Medical Center, 2222 Welborn Street, Dallas, TX 75219. E-mail:

© 2014 by Lippincott Williams & Wilkins