Infectious complications associated with toothpick injuries of the hand

Abstract Purpose: Although rare, hand injury caused by toothpicks can result in serious complications similar to hand injury produced by human biting. To emphasize its clinical significance this article describes a group of patients sustaining hand injury induced by toothpicks. Method: Eight patients who developed cellulitis, abscess, septic arthritis, and/or pyogenic tenosynovitis of flexor tendons after toothpick injuries of the hand were treated at our hospital. Seven of them required admission for antibiotics and surgical treatment. Results: The 7 admitted patients required multiple debridements (3 times on average) to control infection and administer intravenous antibiotics for mixed aerobic and anaerobic infections showing in wound cultures. The average hospital stay for the 7 patients was 26 days. At follow-up evaluation, 4 patients had full recovery of hand function after various cutaneous flap resurfacing of the wounds or staged tendon reconstruction, whereas the remaining 4 patients had arthritis with flexion contracture of interphalangeal joints or persistent paresthesia of the finger. Conclusions: Patients injured by contaminated toothpicks should be treated with antibiotics that inhibit the growth of both aerobic and anaerobic organisms immediately after these organisms have been identified from cultures. Moreover early surgical treatment might avoid complications and obtain satisfactory results. (J Hand Surg 2003;28A:327-331. Copyright © 2003 by the American Society for Surgery of the Hand.)