Open joint injury: Difference between revisions

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==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 distruptions (flapsm avulsions, or degloving)
+
* 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==
 
==Management==
  +
* Should have OR for exploration and washout within 6 to 24 hours
* Perioperative antibiotics until 24 to 48 hours postoperative
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*Perioperative antibiotics until 24 to 48 hours postoperative
  +
**No specific risk factors: [[cefazolin]]
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**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]]
   

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

Further Reading

  • Open joint injuries. Classification and treatment. Clin Orthop Relat Res. 1989(243):48-56. PMID: 2721074