Gunshot Injuries of the Knee-Joint in a Base Hospital

Abstract

AT the base hospitals it was possible to keep for treatment, for a period varying from one to three months, patients who by necessity were evacuated from the evacuation hospitals in a few hours after their operation. The results of certain operative procedures, complications arising in special types of injuries as well as the probable functional results in these injuries, could therefore be observed at the base hospital. In this paper, gunshot wounds of the knee-joint will be so considered.The primary operations in injured knee-joints were usually done at the evacuation hospitals where the policy of operative interference was fairly uniform. Through and through machine-gun bullet wounds of the knee without marked destruction of the articular surfaces were not usually operated upon. Haemarthrosis or marked effusion into the joint in such cases was usually aspirated. Practically all penetrating and perforating wounds from high explosives were operated as soon as possible, the wounds of the soft parts debrided, foreign bodies and loose bone fragments removed from the joint, and the capsule of the joint closed if possible. If infection had already manifested itself or was probable, the joint was left open. Long oblique fractures into the joint were usually subjected to a d6bridement of the wound over the fracture and the joint was not opened. It was, as a rule, not possible to hold these cases at the front more than forty-eight hours, and they were evacuated with the joint immobilized in a Thomas splint to the base hospital, where they were held until complications were cared for and a definite convalescence established.A group of such injuries in Base Hospital No. I3 will be considered from the standpoint of the original lesion, the type of operation performed at the front, the subsequent complications and their treatment as related to the function of the joint. Fifty-five cases had sufficiently good records for study. Forty-nine were operated at the front on an average of I.8 days after their injury and of these forty-two were operated within twenty-four hours after injury. Of the whole group thirty-one or fiftysix per cent. remained uninfected after operation, and twenty-four or forty-four per cent. became infected. The influence of early operation in prevention of infection is instanced in the seven joints operated later than twenty-four hours after injury. Five became infected, the average time of operation being eight days after injury.Infection is the most important factor in decreasing the ultimate usefulness of the joint. The type of injury to the joint, the post-oper-290

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty

“…Penetrating injuries to the knee are encountered both in civilian trauma and during military combat operations. [1][2][3][4][5][6][7][8][9] In the military, these injuries most frequently result from explosive blasts or bullets. 10 Aside from the soft tissue involvement, these open wounds may involve varying degrees of bone and cartilage destruction.…”