Open joint injury: Difference between revisions
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==Classification== |
==Classification== |
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* Type I: single penetration with out extensive soft tissue damage |
* Type I: single penetration with out extensive soft tissue damage |
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* Type II: Single or multiple penetrations with extensive soft tissue |
* Type II: Single or multiple penetrations with extensive soft tissue disruptions (flaps, avulsions, or degloving) |
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* Type III: open periarticular fractures with extension through the adjacent intraarticular surface |
* Type III: open periarticular fractures with extension through the adjacent intraarticular surface |
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* Type IV: open dislocations or those with associated nerve or vascular injury requiring repair |
* Type IV: open dislocations or those with associated nerve or vascular injury requiring repair |
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==Management== |
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* Should have OR for exploration and washout within 6 to 24 hours |
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*Perioperative antibiotics until 24 to 48 hours postoperative |
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**No specific risk factors: [[cefazolin]] |
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**MRSA likely: [[vancomycin]] |
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**Extensive soft-tissue injury: add gram-negative coverage ([[ceftriaxone]], [[Aminoglycosides|aminoglycoside]], etc) |
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**Fecal contamination: add high-dose [[penicillin]] (for [[Clostridium]]) |
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**Seawater contamination: add [[doxycycline]] (for [[Vibrio vulnificus]]) |
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*See also [[Antibiotic prophylaxis for open fractures]] |
*See also [[Antibiotic prophylaxis for open fractures]] |
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== Further Reading == |
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* Open joint injuries. Classification and treatment. ''Clin Orthop Relat Res.'' 1989(243):48-56. PMID: [https://pubmed.ncbi.nlm.nih.gov/2721074/ 2721074] |
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[[Category:Trauma and surgical patients]] |
[[Category:Trauma and surgical patients]] |
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Latest revision as of 16:16, 4 April 2022
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
