Open joint injury

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