Open joint injury: Difference between revisions
From IDWiki
(→) |
(→) |
||
| (2 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
==Classification== |
==Classification== |
||
* Type I: single penetration with out extensive soft tissue damage |
* Type I: single penetration with out extensive soft tissue damage |
||
| − | * 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) |
* Type III: open periarticular fractures with extension through the adjacent intraarticular surface |
* 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 |
* 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]], [[Aminoglycosides|aminoglycoside]], etc) |
||
| + | **Fecal contamination: add high-dose [[penicillin]] (for [[Clostridium]]) |
||
| + | **Seawater contamination: add [[doxycycline]] (for [[Vibrio vulnificus]]) |
||
*See also [[Antibiotic prophylaxis for open fractures]] |
*See also [[Antibiotic prophylaxis for open fractures]] |
||
| + | |||
| + | == Further Reading == |
||
| + | |||
| + | * Open joint injuries. Classification and treatment. ''Clin Orthop Relat Res.'' 1989(243):48-56. PMID: [https://pubmed.ncbi.nlm.nih.gov/2721074/ 2721074] |
||
[[Category:Trauma and surgical patients]] |
[[Category:Trauma and surgical patients]] |
||
Latest revision as of 12:16, 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
