• H R Smith, H Hartman, J Loveridge, and R Gunnarsson.
• Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia. hamish.smith@my.jcu.edu.au.
• Eur J Trauma Emerg Surg. 2016 Dec 1; 42 (6): 701710701-710.

PurposeThe tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries.MethodsMEDLINE, Scopus and CINAHL were used as the literature sources.Inclusion CriteriaOriginal research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication.Exclusion CriteriaCase studies, case series and review articles were not included.ResultsAfter duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each.ConclusionIncreased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs.Systematic Review Registration NumberPROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

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