The wound was opened and irrigated with a large volume of saline.No bacterium was detected on exudate culture,and isolation or identification was not possible. On the basis of the clinical symptoms,tetanus was diagnosed and treatment was initiated. TlG (6000 units)was intravenously administered on the day of onset,and 6000 units of TlG and 0.5 mL of intramusclar tetanus toxoid were administered the following day.We administered treatment with penicillin antibiotics. However,the convulsions did not remit
and,in fact, slowly became aggravated. Thus,tracheal intubation was performed,and our patient underwent artificial respiratory management. Anticonvulsant and sedative were concomitantly administered, but convulsion was readily induced by light stimulation, such
as irrigation of the wound. The freguency and intensity of convulsive seizures started to decrease slightly at about 10 days after onset,and a tapering of the intravenous anticonvulsant injection was initiated. Our patient was weaned from the ventilator 12 days after onset. The distal phalanx fracture of his ring finger healed 6 weeks after the
injury. Conservatve treatment of the open wound of his middle finger was continued,and the wound healed 8 weeks after the injury. The fingertip morphology of his middle finger was relatively favorable,but owing to rest for tetanus treatment, rehabilitation could not be performed,and joint contracture remained in his right middle and ring fingers.No systemic problem occurred afterward,and our patient was discharged 12 weeks after the injury.