"I would like to know more about how to treat bloody knuckles. I've had them once and my roommate gets them occasionally. What's the best way to care for them so they will heal quickly and how do you check to know that there is no serious injury to the hand?"

-Bobbi

This is a great question, Bobbi.

Bloody knuckles are a thing to avoid if possible. Do not hit the teeth as this can cause nasty infections if a tooth gets into a tendon. You do not want a blood exchange with some street punk.

To prevent cutting soak your hands in warm salt water daily and hit a light bag with bare knuckles regularly to callous the skin. Stop short of the skin tearing. Just let it get red and abraded.

If you hit some thug in the teeth and bloody your knuckles: irrigate with peroxide, followed by alcohol, followed by cold water, followed by antisceptic ointment and knuckle band-aids.

On the street you want to hit the head with your open hand, the eyes with your speared fingertips, the nose with a thumb-side up vertical fist and the chin with a palm down pronated fist. Do this and prep your knuckles and they won’t bleed.

Serious injury to the hand will be indicated by out-of-position knuckles. The most common is the boxer’s fracture, where the two small knuckles hit something hard like a skull and the two small supporting metacarpals snap, causing a lump between knuckles and wrist and the falling out of line of one or two of the weak knuckles.

Swelling of the back of the hand may indicate a broken metacarpal.

Swelling of the middle knuckle is a common boxing ailment which requires ice, elevation and rest to heal.

The worst hand injury is a broken metacarpal behind one of the two big knuckles, which may require surgery.

The next to worst hand injury is a broken or sprained thumb. This commonly happens when throwing hooks and uppercuts to the body—so don’t do that without gloves on. It also happens when throwing a palm-down pronated punch that gets ducked and the thumb snaps on the skull.

Out-of-place knuckles require a doctor’s attention. Emergency room docs fix these all the time.

Bobbi, you can slaughter a guy in a bare knuckle fight without tearing up your knuckles—that is the key: preparation of the hand, proper use of the fist and accurate punching, the straighter the better.

You want his face swollen and bloody, not your hands. If you have decked some dude that deserves punishment and you go to town on his head and face, this often results in messed up knuckles, sometimes catching some pavement or a floor tile with the fist. So hit him in the head with your palm and drive the other side of his head into the pavement. Or just stay up and kick his ribs and stomp his ankles and hands. Do not kick his head or stomp the chest as he might die on you and that's worse than bloody knuckles.