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