Open joint injury
From IDWiki
Classification
- Type I: single penetration with out extensive soft tissue damage
- Type II: Single or multiple penetrations with extensive soft tissue disruptions (flaps, avulsions, or degloving)
- Type III: open periarticular fractures with extension through the adjacent intraarticular surface
- Type IV: open dislocations or those with associated nerve or vascular injury requiring repair
Management
- Should have OR for exploration and washout within 6 to 24 hours
- Perioperative antibiotics until 24 to 48 hours postoperative
- No specific risk factors: cefazolin
- MRSA likely: vancomycin
- Extensive soft-tissue injury: add gram-negative coverage (ceftriaxone, aminoglycoside, etc)
- Fecal contamination: add high-dose penicillin (for Clostridium)
- Seawater contamination: add doxycycline (for Vibrio vulnificus)
- See also Antibiotic prophylaxis for open fractures
Further Reading
- Open joint injuries. Classification and treatment. Clin Orthop Relat Res. 1989(243):48-56. PMID: 2721074
