Septic Arthritis of the Proximal Interphalangeal Joint After Rattlesnake Bite

• Published in: The Journal of hand surgery (American ed.) Vol. 47; no. 5; pp. 484.e1 - 484.e4
• Main Authors: Gelman, Daniel, Bates, Taylor, Nuelle, Julia A.V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Animals; Arthritis, Infectious; Crotalus; Dark-field; Foreign Bodies - complications; foreign body; Humans; Orthopedics; phase-contrast; rattlesnake; septic arthritis; Snake Bites - complications; Snake Bites - therapy; Snake Venoms; rattlesnake; phase-contrast; Dark-field; septic arthritis; foreign body; Rattlesnake; dark-field
• ISSN: 0363-5023; 1531-6564; 1531-6564
• DOI: 10.1016/j.jhsa.2021.04.004

Snake bites are an uncommon injury requiring intervention by hand surgeons. While counteracting the effects of snake venom is the initial and urgent concern following a bite, infection caused by retention of a foreign body can present in a delayed fashion and may lead to increased morbidity. Standard radiographs of the injury should be carefully examined for foreign bodies, noting that retained snake teeth are somewhat radiolucent due to less mineralization as compared to bone and can be difficult to visualize. In our subject, a retained rattlesnake fang was found in association with a septic interphalangeal joint despite appropriate radiographic evaluation and thorough surgical irrigation and debridement upon initial presentation. This case report highlights a potential complication of snake bites, the importance of aggressive management, and the importance of increased suspicion for retained foreign bodies. Augmenting plain radiographs with additional imaging modalities, such as ultrasound, dark-field, and phase-contrast imaging, may aid in the diagnosis of retained foreign bodies after snake bites.