Open Joint Injuries


- See:
       Gun Shot Wounds
       Plumbism
       Open Fractures
       Septic Joint

- Classifaction of Open Joint Injuries: (from Collins and Temple (1992))
    - type 2:
          - single capsular perforation or laceration w/o extensive soft tissue injury
          - A: w/ minimal step off (less than 2 mm) or comminution (less than 1 sq cm) to the articular surface;
          - B: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm;
          - C: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm, w/ biarticular surface injury, or meniscoligamentous disruption;
    - type 2:
          - single or multiple capsular perforations or lacerations w/ extensive soft tissue injury;
          - A: w/ minimal step off (less than 2 mm) or comminution (less than 1 sq cm) to the articular surface;
          - B: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm;
          - C: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm, with biarticular surface injury, or meniscoligamentous disruption;
    - type 3:
          - open periarticular frx w/ extension thru the adjacent intra-articular surface;
          - A: w/ minimal step off (less than 2 mm) or comminution (less than 1 sq cm) to the articular surface;
          - B: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm;
          - C: w/ signficant step off (more than 2 mm) and/or comminution more than 1 squ cm, with biarticular surface injury, or meniscoligamentous disruption;
      - Open joint injuries: classification and treatment.


- Antibiotics:
    - antibiotic prophylaxis
    - begin appropriate antibiotic therapy in the emergency room & continue for two or three days only;
    - tetanus prophylaxis
    - ref: The use of antibiotics in open fractures.


- Debridement and Irrigation:
    - goal is to avoid infection, removal of loose bodies, and avoidance of lead toxicity;
    - skin preparation:
            - common antiseptics
    - immediately debride the wound using copious irrigation (9 lit) and, for type-II and type-III fractures, repeat the debridement in 24 to 72 hours;
    - after low velocity GSW, arthroscopy may reveal meniscal tears in 70% and free floating debris in 70% of patients
    - references:
            - Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures.
            - The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds. An experimental study.
            - Intraarticular findings after gun shot wound through the knee.
            - Arthroscopic debridement after intraarticular low velocity gun shot wound



The early management of open joint injuries. A prospective study of one hundred and forty patients.

Lead arthropathy: arthritis caused by retained intra-articular bullets.

Open joint injuries: classification and treatment.

Low Velocity Gunshot Wounds Involving the Knee Joint: Surgical Management.

Gun shot wound to the knee.

Gun Shot Wounds to the Knee.

Tissue toxicity of antiseptic solutions. A study of rabbit articular and periarticular tissues.

The management of civilian intra-articular gunshot wounds: treatment considerations and proposal of a classification system.

Sensitivity of the Saline Load Test With and Without Methylene Blue Dye in the Diagnosis of Artificial Traumatic Knee Arthrotomies.

Computed Tomography Scan to Detect Traumatic Arthrotomies and Identify Periarticular Wounds Not Requiring Surgical Intervention: An Improvement Over the Saline Load Test.

Computed Tomography Scan to Detect Intra-Articular Air in the Knee Joint: A Cadaver Study to Define a Low Radiation Dose Imaging Protocol.

The Saline Load Test of the Knee Redefined: A Test to Detect Traumatic Arthrotomies and Rule-out Periarticular Wounds Not Requiring Surgical Intervention.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, January 21, 2013 12:42 pm