Open Upper-Limb Fractures Secondary to Animal Bites: Epidemiology, Management and Outcomes in a 10-Year Retrospective Series

¹Department of Orthopedic Surgery and Traumatology, Sfax University Hospital Center, University of Sfax, Tunisia

²Emergency Department, Sfax University Hospital Center, University of Sfax, Tunisia

³Department of Infectious Diseases, Sfax University Hospital Center, University of Sfax, Tunisia

Corresponding author: Mohamed Mokhtar Jmal, MD, Department of Orthopedic Surgery and Traumatology, Sfax University Hospital Center, University of Sfax, Tunisia, E-mail: [email protected]

Received Date: December 17th, 2025

Publication Date: February 16, 2026

Citation: Jmal MM, et al. (2026). Open Upper-Limb Fractures Secondary to Animal Bites: Epidemiology, Management and Outcomes in a 10-Year Retrospective Series. Surgeries.6(1):14.

Copyright: Jmal MM, et al. © (2026).

ABSTRACT

Background: Upper-limb open fractures resulting from animal bites represent an unusual yet severe constellation of injuries. Their dual mechanism — skeletal disruption combined with heavily contaminated bite wounds — exposes patients to high infectious risk and often leads to prolonged rehabilitation and delayed professional reintegration. Such injuries require urgent, coordinated medical and surgical management. Objective: To define the epidemiological profile of victims, evaluate acute medical and surgical management, assess functional and radiological outcomes, and identify prognostic factors associated with these complex injuries. Methods: A retrospective review was conducted over ten years (2008–2017) in the Department of Orthopaedics and Traumatology of Habib Bourguiba University Hospital, Sfax. Twenty patients presenting with open upper-limb fractures due to animal bites were included. Minimum follow-up was 12 months. Data included demographics, circumstances of injury, anatomical distribution, management protocols, complications and outcomes. Results: Twenty patients were included (12 men, 8 women; mean age 55 years). Occupational accidents predominated (35 percent). Donkeys and horses were the most frequent aggressors, consistent with previous reports from rural and agricultural regions. Fifteen patients sustained hand injuries, predominantly involving the phalanges; the remaining cases involved the wrist and forearm. Emergency management consisted of meticulous wound decontamination, dressing, immobilization, tetanus and rabies immunization, and broad-spectrum antibiotic prophylaxis, in accordance with WHO and international recommendations. Surgical exploration revealed vascular lesions in eight cases, nerve injuries in two, and tendon lesions in eight, highlighting the polymorphic and destructive nature of equine and donkey bites described in prior literature. Fracture stabilization involved external fixation in 10 patients, K-wire fixation in 7, and orthopaedic treatment in 3, reflecting accepted strategies for contaminated open fractures. Outcome was favourable in 19 patients. One case of nonunion was observed. No cases of tetanus or rabies occurred. No clinically documented deep infection was recorded during follow-up. Conclusion: Open upper-limb fractures caused by animal bites constitute severe surgical emergencies. Their management demands a multidisciplinary approach integrating trauma surgery, infectious disease expertise, and rehabilitation. Prevention remains paramount, particularly through education of agricultural workers and vaccination of domestic and working animals.