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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 2  |  Issue : 2  |  Page : 27-28

SnakeBite wound with open volar proximal interphalangeal joint dislocation of little toe: An uncommon rural case


Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission19-Feb-2021
Date of Acceptance04-Apr-2021
Date of Web Publication23-Aug-2021

Correspondence Address:
Ganesh Singh Dharmshaktu
C/O Dr Y.P.S. Pangtey, Ganga Vihar, Malli Bamori, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jssrp.jssrp_4_21

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  Abstract 


Snake-bite injuries are uncommon events but a significant number of cases are reported from rural areas. The basic principles of diagnosis and management of snake-bite injuries should be known to rural practitioners and prompt referral should be done in selected cases. The extremity bite may occasionally result in localized cellulitis and soft tissue infection that may complicate later into underlying bone invilement. Dislocation following the open wound in these setting is rare occurrence that needs proper knowledge for its diagnosis and management.

Keywords: Cellulitis, extremity, snake-bite, open dislocation, wound


How to cite this article:
Dharmshaktu GS. SnakeBite wound with open volar proximal interphalangeal joint dislocation of little toe: An uncommon rural case. J Surg Spec Rural Pract 2021;2:27-8

How to cite this URL:
Dharmshaktu GS. SnakeBite wound with open volar proximal interphalangeal joint dislocation of little toe: An uncommon rural case. J Surg Spec Rural Pract [serial online] 2021 [cited 2021 Oct 19];2:27-8. Available from: https://jssrp.org/text.asp?2021/2/2/27/324482




  Introduction Top


Snakebite injuries are not uncommon problems encountered in the rural practice and may be fatal in many cases. The clinical presentation largely depends on the type of snake and duration of presentation. Nonvenomous snakebite often leads to the local site complications such as surrounding soft-tissue wound and selling. On rare instances, the spread of infection to adjacent bone or joint may also present in myriad ways. Patient consent was taken for this reporting.


  Case Report Top


A 55-year-old male patient presented to us with a history of snakebite wound over the right lateral toe region 6 months ago. The bite was nonfatal and no information about the type of snake was available. Initially, there was a history of swollen little toe and adjoining area with ecchymosis and cellulitis that was managed by local practitioner with indigenous dressing leading to clinical improvement. There was a history of multiple debridement of the wound and multiple dressings. As the swelling reduced and most other wounds got healed, the wound over the little toe remained open, although with no discharge or clinical signs of infection. The bones were later exposed displaying volar dislocation of little toe proximal interphalangeal joint [Figure 1]a and [Figure 1]b with adjacent skin discoloration. As the wound was not healed, the patient preferred amputation of little toe following informed consent and the procedure was performed [Figure 1c]. There was no wound-related problem noted in the follow-up and patient was performing the activities of daily living without any discomfort or pain.
Figure 1: The clinical picture showing wound over little toe with exposed proximal interphalangeal joint in volar dislocation (a). The radiograph confirming the fifth proximal interphalangeal joint dislocation (b) that was managed by amputation of the toe (c)

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  Discussion Top


Pain, ecchymosis, blister formation, edema, and cellulitis are other associated features of localized soft-tissue complications. Proteolytic nature of snake venom leads to the varying grades of tissue necrosis. Venom from the viper family of snakes has thrombin like effect leading to localized vasculopathy.[1],[2] Secondary bacterial infection is additional complication related to chronic nonhealing aforementioned complications.[2],[3] Infected wounds may result in protracted course of treatment and suboptimal outcome. It is possible for wounds to result in bone or joint involvement as noted in our case. There is one similar report of open first metacarpophalangeal joint dislocation following cellulitis associated with snakebite (viper in that case). Debridement and wire fixation of the joint was done followed by regular dressing leading to good clinical outcome.[4] Our patient had long-standing exposed bones without periosteal or soft-tissue cover and amputation was preferred by the patient. The uncontrolled spread of infection to wider area may further complicate the management of these wounds. As the rural areas are more prone to having snake habitat resulting in increased risk of snakebite injuries, the provisions for necessary emergency and early management in the primary care level are very important. The various clinical presentation and management methods should be known to the doctor and health-care workers working in the rural region. The common and uncommon presentation of the snakebite wound and their management requires frequent revision in the rural hospitals. This case snippet may be educative in the primary and rural care setting with respect to managing snakebite wounds.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nelson BK. Snake envenomation. Incidence, clinical presentation and management. Med Toxicol Adverse Drug Exp 1989;4:17-31.  Back to cited text no. 1
    
2.
Rojnuckarin P, Mahasandana S, Intragumthornchai T, Sutcharitchan P, Swasdikul D. Prognostic factors OGF green pit viper bites. Am J Trop Med Hyg 1998;58:22-5.  Back to cited text no. 2
    
3.
Garg A, Sujatha S, Garg J, Acharya NS, Chandra Parija S. Wound infections secondary to snakebite. J Infect Dev Ctries 2009;3:221-3.  Back to cited text no. 3
    
4.
Balaji G, Kumar A, Menon J. Snake bite induced cellulitis leading to infected open dislocation of the first metacarpophalangeal joint - A rare complication. J Clin Orthop Trauma 2015;6:195-8.  Back to cited text no. 4
    


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