- 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;
- 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.
- Intra-articular findings after GSW through the knee.
P Tornetta and RC Hui.
J. Orthop. Trauma. Vol 11, No 6, p 422-424.
- Arthroscopic debridement after intra-articular low velocity GSW.
E Berg, JV Ciullo. Arthroscopy. Vol 9. 1993. p 576-579.
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. Collins DN, Temple SC.
CORR: 243: 48-56, 1989.
Low Velocity Gunshot Wounds Involving the Knee Joint: Surgical Management. Ashby, M.
JBJS 56-A: 1047-1053, 1974.
Gun shot wounds to the knee. L Dean, V Dvonch. Orthopedics 1988. 963-965.
Gun Shot Wounds to the Knee. DJ Perry, DP Sanders, CD Nyirenda, JT Lezine.
Orthop Clin North Am. Vol 26. 1995. p 155-163.
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.
