Bites to hands may be beastly.

• Position: Wounds

Hand injuries frequently are caused by human and animal bites, prompting as many as 330,000 emergency department visits in the U.S. each year. A literature review appearing in the Journal of the American Academy of Orthopaedic Surgeons outlines the potential complications of human and animal bites to the hand, the importance of early injury assessment, and the use of antibiotic and other treatment methods to avoid infection, permanent disability, and amputation.

"Although many people may be reluctant to immediately go to a doctor, all bites to the hand should receive medical care," says orthopaedic surgeon and lead study author Stephen A. Kennedy. 'While routine antibiotics are not necessarily recommended for other bite wounds, they are recommended for a bite to the hand to reduce the risk of infection and disability."

Human bites to the hand--while accounting for only two to three percent of all hand bite injuries--can occur during altercations and include wounds caused by punching-type contact with the mouth or teeth, domestic abuse, or accidentally during sports, play, or other activities. Human bites to the fingers and hand that penetrate the skin can transmit infection through oral flora, or saliva, which contains more than 600 bacterial species.

Animals also have saliva containing a broad range of bacteria. Adult dog jaws, especially among larger breeds, are capable of exerting a bite force of more than 300 pounds and, when combined with the variety and sharpness of their teeth--designed to clamp, hold, tear, and crush food--can cause significant injuries to hand and finger ligaments, tendons, and bones.

Cats do not have the jaw strength of dogs although their sharp, narrow teeth also can cause serious injury. An estimated 30% to 50% of cat bites are complicated by infections, which can occur as early as three hours after injury in approximately 50% of the infection cases. Infections due to dog bites typically occur at less than half the rate of cat bites. Statistics indicate that:

* More than half of all Americans will sustain an...