Answer 4: Local wound care, tetanus prophylaxis, and administration of IV antibiotics have been showed to be appropriate for low-velocity intra-articular GSWs. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Brubacher, Dr. Grote, and Dr. Tilley. located just lateral to peroneus tertius and superficial peroneal nerve and medial to lateral malleolus can trace out superficial peroneal nerve prior to incision Anterocentral function anterior viewing portal location and technique not commonly utilized due to danger to dorsal pedis artery medial to EDL and lateral to EHL Posterolateral function PDF Constraint in Primary Total Knee Arthroplasty - Orthobullets 2023 Lineage Medical, Inc. All rights reserved, TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique. A positive study is clearly evident with either modality (eg SLT with extrusion of fluid, CT with free air in joint). J Orthop Trauma 2007; 21: 442443. Calcaneal Lengthening Osteotomy. (Russell M. Nord, Tony Quach, Michael Walsh, David Pereira and Nirmal C. \ Tejwani \240 )Tj There is a small body of literature indicating that computerized tomography (CT) scanning of the knee joint may have a significant role in ruling out traumatic arthrotomies. Detection of a traumatic arthrotomy in the pediatric knee using the saline solution load test. He has some pain with range of motion of his knee but states that his pain is mostly around the area of the laceration. Traumatic Arthrotomy. Drape the knee with sterile towels, exposing only the sterilized skin of the knee. 2014;72(1):61-9. Different countries in which training hospitals use our PASS Enterprise analytics platform. <>stream <> Increases the risk of joint infection and is cause for emergent orthopedic evaluation and treatment for joint exploration and washout. 106 0 obj Before 0 g Also known as "traumatic arthrotomy". Injury 2013; 44: 14981501. Open knee joint injuries--an evidence-based approach to management. al., 2009). cefazolin or cefuroxime), If risk factors for MRSA present, use agent with activity against MRSA (i.e. 2023 Lineage Medical, Inc. All rights reserved. TECHNIQUE VIDEO. Healthcare. Does the saline load test still have a role in the orthopaedic world? Fifty-six consecutive patients scheduled for knee arthroscopy were enrolled. Open joint injury - WikEM While these injuries can occur at any Treatment is observation, NSAIDs, tramadol and corticosteroids for minimally symptomatic patients. As saline is injected, inspect joint for saline extrusion. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. Inject 2-4 mL lidocaine 1-2% (+/- epi) in a contralateral position to the injury, tracking along the planned aspiration pathway. pinning across joint with .062-inch K-wires Ulnar Styloid Fractures Reflects high degree of initial fracture displacement Fractures through base often associated with TFCC rupture and instability In the absence of instability, ulnar styloid nonunions are not associated with worse outcomes Treatment nonoperative cast immobilization indications Quite useful for orthopaedic residents, GPs and med students. eCollection 2020 Jan. J Orthop Case Rep. 2021 Mar;11(3):107-112. doi: 10.13107/jocr.2021.v11.i03.2110. ranges between 1.8% to 27% depending on the bone involved and fracture characteristics. /T1_2 1 Tf The knee joint capsule itself can be violated by soft tissue injuries near the joint; this constitutes a surgical emergency that usually will require urgent orthopedic consultation. He reports falling onto his left knee, then sliding to a stop under a parked car, colliding with a grate on the street. Orthopedic Emergencies 2017. You can read the full text of this article if you: You may be trying to access this site from a secured browser on the server. 150 cc saline load into joint has high negative predictive value and 95% sensitivity in detecting small joint injuries. Evaluation of saline load test for simulated traumatic arthrotomies of the ankle. Rarely life threatening: Open knee joint injuries--an evidence-based approach to management Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies. A systematic review of the literature. In the absence of intra-articular pathology, intra-articular gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. <>/Filter/FlateDecode/Height 390/Length 66931/Name/X/Subtype/Image/Type/XObject/Width 900>>stream endstream /T1_1 1 Tf Sensitivity of the Saline Load Test for Traumatic Arthrotomy of the The mean volumes of injected fluid needed for a positive result at the inferomedial and superomedial needle locations were 64.0 and 95.2 mL, respectively; this difference was significant (p = 0.01). Feathers T et al. old incisions should, as best as possible, be crossed at 90 degrees. Data is temporarily unavailable. Results: None of the 31 patients with -iaCT had a knee infection at a mean follow-up of 291.0 548.1 days. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. Ligaments, cartilages, and tendons are key structures both around and outside the joint. Journal of the American Academy of Orthopaedic Surgeons, Get new journal Tables of Contents sent right to your email inbox, Articles in PubMed by Jacob W. Brubacher, MD, Articles in Google Scholar by Jacob W. Brubacher, MD, Other articles in this journal by Jacob W. Brubacher, MD. In the absence of intra-articular pathology, intra-articular gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection and may be treated with local wound care, tetanus, and IV antibiotics. +v1x30d0``]A`6 IX0Q!A\1A@L 1 Hip Direct Lateral Approach (Hardinge, Transgluteal) Hip Posterior Approach (Moore or Southern) Thoracic Spine. Total knee arthroplasty - UpToDate 0000001968 00000 n J Orthop Traum 2012; 26: 3479. J. Orthop. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. proximal portion of the arthrotomy extends into the muscle belly of the vastus . PDF Detection of Traumatic Arthrotomy of the Knee Using the Saline Solution When one considers that a typical synovial fluid volume of the knee is around 7 mL [pmid 8779258], injecting 150 mL or more into that joint is a procedure that will require logistical planning and coaching of a cooperative patient. 105 0 obj Background: 0 1.00001 TD 14. -3.61601 -3.8 Td )Tj 0 1 TD J Bone Joint Surg Am. 0000071241 00000 n Exam is notable for a deep laceration slightly inferior and lateral to his left patella. %%EOF Posterior Approach to Thoracolumbar Spine. 0000003871 00000 n document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); How To Confidently Rule Out Traumatic Arthrotomy of the Knee. (20 Pickering Street, Needham, MA 02492-3157)Tj 2023 Lineage Medical, Inc. All rights reserved. 2023 Lineage Medical, Inc. All rights reserved, Approaches | Knee Medial Parapatellar Approach, most structures of the anterior aspect of knee, support heel when knee is flexed to 90 degrees, spinal, epidural, sciatic and/or femoral blocks, tape sandbag under hip to internally rotate leg, divide subcutaneous tissues below skin incision, take care not to damage the anterior insertion of the medial meniscus (irrelevant for TKA), if difficult to flip patella then extend incision between rectus femoris and vastus medialis proximally, if contractures continue to prevent dislocation of the patella then can detach tibial tuberosity bone block and reattach afterwards with a screw, flex knee to 90 degrees to gain exposure to entire knee joint, incise between rectus femoris and vastus medialis, split underlying vastus intermedius to expose femur, proximal portion of the arthrotomy extends into the muscle belly of the vastus medialis, patella can be difficult to evert and is subluxated laterally instead, muscle belly of the vastus medialis is lifted off the intermuscular septum, preserving the blood supply to the patella, preserving the anatomy of the quadriceps tendon (maintains stability of knee), at risk during lateral retinacular release, may be last remaining blood supply after medial parapatellar approach and fat pad excision, saphenous nerve becomes subcutaneous on medial aspect of knee after piercing the fascia between the sartorius and gracilis, saphenous nerve then gives of infrapatellar branch that provides sensory to the anteromedial aspect of the knee, if cut during surgery, resect and bury end to decrease chance of painful neurom, cutaneous blood supply may be tenuous in cases of previous surgery (revision TKA) or poor host (rheumatoid etc. Injection sites were randomized to either a superomedial or inferomedial location. BT Nguyen et al. (Reprints and Permissions)Tj Knee Medial Parapatellar Approach - Approaches - Orthobullets A similar study found 95% sensitivity at a volume of 155 mL. Preoperative Patient Care. J Orthop Trauma. Hip Anterior Approach (Smith-Petersen) Hip Anterolateral Approach (Watson-Jones) Hip Medial Approach. Evaluation of periarticular traumatic wounds for joint penetration is a common clinical concern for orthopaedic surgeons. <>stream endobj Answer 3: Trans-abdominal intra-articular GSWs are considered contaminated. Type in at least one full word to see suggestions list. Springer, Cham, Metzger et al. Diagnosis is made clinically by assessing the size and nature of the external wound as well as obtaining radiographs of the bone at the location of the soft tissue injury. PDF Total Knee Arthroplasty in the Valgus Knee - Orthobullets Knee osteoarthritis is degenerative disease of the knee joint that causes progressive loss of articular cartilage. They concluded that in the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Are you sure you want to trigger topic in your Anconeus AI algorithm? PMID: 25150328, Makhni MC. Unauthorized use of these marks is strictly prohibited. Trauma 2013; 27: 498504. Sterilize the skin of the lower extremity from distal quadriceps to proximal calf with betadine or chlorhexidine. The injection of normal saline solution at a rate of 5 mL/sec through an 18-gauge needle was continued while the knee was moved through a range of motion until fluid extravasated from the iatrogenic laceration. (\240)Tj I feel like inserting a needle and injecting into a joint space would track air into that space and then your CT would not be properly interpretable. The knee is comprised of the structures that surround the bony articulations of the femur, tibia, fibula, and patella. 0000001774 00000 n 111 0 obj /T1_0 1 Tf Gun shot wounds (GSWs) are high energy injuries that contribute to extensive soft tissue damage and comminuted bony fractures. 101 0 obj Other studies revealed a false negative rate of 67% with volumes up to 105 mL (saline + methylene blue) and 95 mL (saline alone) and sensitivities of only 36% at volumes of 60 mL. by the American Academy of Orthopaedic Surgeons. Hip Arthroscopy - Knee & Sports - Orthobullets Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies. Treatment depends on location of fracture but generally requires immediate IV antibiotics and urgent irrigation and debridement followed by surgical fixation as needed. Transthoracic approach to thoracic spine. ET 97 0 obj 15 0 0 15 72 513.99997 Tm Goyal N, Bohl DD, Frank RM, Slikker W 3rd, Fernandez JJ, Cohen MS, Wysocki RW. 96 0 obj J. Orthop. BT The https:// ensures that you are connecting to the muscle belly of the vastus medialis is lifted off the intermuscular septum. The potential advantage of /T1_1 1 Tf Additionally, open knee joint injuries have a high rate of associated periarticular fractures (51%). PMID: 23490316. The clinician uses a sterile technique to inject saline into the knee (or other joint space) using an 18g needle and syringe (Nord, et. PMID: Metzger et al. PMID: 22215059, Your email address will not be published. endobj S often associated with additional injuries (30%), the presence of an open wound does not preclude the occurrence of compartment syndrome in the injured limb, obtain information regarding mechanism, location, and timing of injury, the size and nature of the external wound may not reflect the damage to the deeper structures, if concern for vascular insult, ankle brachial index (ABI) should be obtained, vascular surgery consult and angiogram is warranted if ABI < 0.9, consider saline load test or CT scan if concern for traumatic arthrotomy, some studies now show CT scan more sensitive than saline load test for the knee, obtain radiographs including joint above and below fracture, evaluation for traumatic arthrotomy of the knee, a soft tissue wound in proximity to a fracture should be treated as an open fracture until proven otherwise, mutlidisciplinary training of open fracture management has been associated with decreased timing to antibiotic administration, antibiotic type indicated by injury pattern and location, ideal time of soft tissue coverage controversial, but most centers perform within 5-7 days, infection rates of open fracture depend on zone of injury, periosteal stripping and delay in treatment, incidence of fracture-related infection range from <1% in type I open fractures to 30% in type III fractures, definitive reconstruction and fracture fixation, once soft tissue coverage is obtained and an adequate sterility is achieved, definitive treatment with internal fixation leads to significantly decreased time to union, improved functional outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation, studies show increased infection rate when antibiotics are delayed for more than, continue for 24 hours after initial injury if wound is able to be closed primarily, continue for 24 hours after final closure if wound is not closed during initial surgical debridement (48 hours for type III wounds), clindamycin or vancomycin can also be used if allergies exist, 1st generation cephalosporin + aminoglycoside, some institutions use vancomycin + cefepime, farm injuries, heavy contamination, or possible bowel contamination, penicillin for anaerobic coverage (clostridium), fluoroquinolones or 3rd or 4th generation cephalosporin, doxycycline + ceftazidime or a fluoroquinolone, toxoid and immunoglobulin should be given intramuscularly with two different syringes in two different locations, guidelines for tetanus prophylaxis depend on 3 factors, complete or incomplete vaccination history (3 doses), splint, brace, or traction for temporary stabilization, decreases pain, minimizes soft tissue trauma, and prevents disruption of clots, remove gross debris from wound, do not remove any bone fragments, place sterile saline-soaked dressing on wound, little evidence to support aggressive irrigation or irrigation with antiseptic solution in the ED, as this can push debris further into wound, recent meta-analysis (GOLIATH study) have, to minimize risk of infection for type III fractures, within 12 hours for type IIIB open tibia fractures, extend wound proximally and distally in line with extremity to adequate expose open fracture, low-pressure bulb irrigation vs. high-pressure pulse lavage, studies have shown that low pressure bulb irrigation is less expensive than high pressure pulse lavage and has no difference in infection rates or union rates, saline vs. saline with castile soap vs. antibiotic solution, studies have shown that saline with castile soap had decreased primary wound healing problems when compared to antibiotic solutions, on average, 3L of saline are used for each successive Gustilo type (i.e 9L for type III), thorough debridement of devitalized tissue is critical to prevent deep infection, bony fragments without soft tissue attachments should be removed, performed at the time of initial debridement, external fixation is temporary initial treatment of choice for majority of high energy open fractures of the lower extremity, significantly contaminated wounds with large soft tissue defects, beads made by mixing methylmethacrylate with heat-stable antibiotic powder, vancomycin and tobramycin most commonly used, early soft tissue coverage or wound closure is ideal. Irrigation and Debridement of Septic Hip - Approaches - Orthobullets. Nonoperative management with local wound care, tetanus prophylaxis +/- short course of oral antibiotics is indicated in low-velocity injury with no bone involvement or non-operative fractures. 454 0 l Incorrect Answers: Answer 2: An arthrotomy is indicated for intra-articular bullet as it may lead to local inflammation, arthritis and lead intoxication (plumbism). Split Anterior Tibial Tendon Transfer. Historically, the saline load test has been the diagnostic test of choice for assessing traumatic arthrotomy; however, CT has recently been shown to have excellent sensitivity and specificity for detecting open knee joint injuries. Brubacher, Jacob W. MD; Grote, Caleb W. MD, PhD; Tilley, Michael B. MD. 2023 Lineage Medical, Inc. All rights reserved. . yj3wNUn%oNd{e]i /T1_1 1 Tf Traditionally, the saline loading test (SLT) has been a staple of investigation for possible traumatic arthrotomy. %PDF-1.6 % 0 g Total Knee Arthroplasty procedure steps - Opulent J Ortho Trauma 2012]. Tornetta and Collins 1 (1996) reported 25 patients in whom a partial medial parapatellar arthrotomy was performed with the knee in a semi-extended position (15-degree bend of the knee joint), with two-thirds of the the retinaculum split. J Orthop Trauma. That is to say, either study alone with a positive finding promptly concludes the diagnostic process, but either study alone with a negative finding leaves diagnostic uncertainty. For more information, please refer to our Privacy Policy. Orthop Rev (Pavia). This site needs JavaScript to work properly. /T1_2 1 Tf There are no studies that directly compare CT to saline loading in a randomized fashion and no studies that propose a definitive algorithm combining these two modalities to exclude knee joint injury. PMID: Konda SR et al. This patient sustained an intra-articular gunshot wound (GSW) without other intra-articular pathology. Ankle Anterior Approach - Approaches - Orthobullets A laceration into the joint exposes the normally sterile intra-articular contents to external contamination, Inoculation of the joint often results in septic arthritis, Laceration over joint which may be large or small, Probe to bottom of wound with hemostat or q-tip. Wolters Kluwer Health Nguyen et al. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. Keller Procedure (resection arthroplasty) indications elderly, low demand patients with significant joint degeneration and loss of motion that allows for rapid rehabilitation contraindications patients with pre-existing rigid hyperextension deformity of 1st MTP joint outcomes good results have been noted in low demand elderly patients ( )Tj ( to use material from this)Tj `1AAGGKhh(t H$*(P( Please enable it to take advantage of the complete set of features! The difficulty is definitively ruling out traumatic arthrotomy. (J Bone Joint Surg Am. 0 0 1 rg patella can be difficult to evert and is subluxated laterally instead. Plain radiographs are negative for fracture. Patella Fractures are traumatic knee injuries caused by direct trauma or rapid contracture of the quadriceps with a flexed knee that can lead to loss of the extensor mechanism. MeSH A systematic review of the literature. endobj Number of times users have rated our content. Moreover, in the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Trauma 2013; 27: 498504. PMID: 17762473, Konda SR et al. Patella Fracture - Trauma - Orthobullets and then performing a CT yield better sensitivity? Question 218990 - Qbank - Orthobullets /T1_0 1 Tf 0.68236 0.1098 0.1647 rg may email you for journal alerts and information, but is committed Bleeding is controlled; the wound base seems appreciable though somewhat limited by maceration of tissue. Healthcare providers who have registered for our community. 0000003779 00000 n presence of different types of knee deformity,easiercorrectionofsevere deformity by eliminating a tight PCL, increased predictability in res-toration of knee kinematics, im-proved range of motion, and poten-tially minimized polyethylene wear because of the option to use more congruent articular surfaces.8-11 Fur-thermore, the PCL can rupture post- eCollection 2021 Dec. Patel AH, Wilder JH, Lee OC, Ross AJ, Vemulapalli KC, Gladden PB, Martin MP 3rd, Sherman WF. Bookshelf An arthrotomy is indicated in these cases. Causes range from acute trauma to chronic systemic disease. Septic Hip Irrigation and Debridement Intra-articular gas seen on radiograph or the development of septic arthritis following a peri-articular wound are generally considered definitive signs of knee joint penetration. Introduction Provides exposure to distal tibia ankle joint talar dome Indications include ORIF of pilon fractures ankle arthrodesis total ankle arthroplasty I&D of infected ankles removal of loose bodies Intermuscular plane Intermuscular plane extensor hallucis longus (deep peroneal nerve) extensor digitorum longus (deep peroneal nerve) Preparation A23-year-old male presents after a bicycle accident. -15.69098 0 Td In one series, a volume of 194 mL was required to achieve a 95% sensitivity for small injuries. A cadaveric study showed that CT demonstrates greater sensitivity for even small volumes (0.1 mL) of air in the joint. Keese GR, Boody AR, Wongworawat MD, Jobe CM. For each patient, a standard 4-mm anteromedial portal was established. /T1_2 1 Tf more severe Gustillo-Anderson classification. arthrotomy, the valgus deformity sufficiently facilitates general expo-sure so that access to the posterolat-eral corner of the knee joint is not difficult, even in patients with ex-treme obesity. ?Yfy{{O0X|}!55566;giR%H?-_jm T+44TvGUUU. You are on your orthopedic trauma rotation at a busy Level 1 trauma center. Required fields are marked *. dedicated hip arthroscopy instruments required. 0000003962 00000 n Are you sure you want to trigger topic in your Anconeus AI algorithm? 8600 Rockville Pike Confirm entry into the joint with aspiration of synovial fluid (assuming remaining synovial fluid after injury). Setup. Future areas of research must focus on further validation of CT evaluation and its use in other major joints, standardizing antibiotic treatment, and further delineating the role of nonsurgical management in minor injuries. /T1_2 1 Tf 13.2 -2.00001 Td Knee Arthroscopy - Approaches - Orthobullets Each diagnostic pathway provides useful information when evaluating for traumatic arthrotomy, and when available, the studies in conjunction may add to diagnostic yield. TECHNIQUE STEPS. Detection of traumatic arthrotomy of the knee using the saline - PubMed 225 0 0 97.5 186.5 612.5 cm African American males are the least likely to receive total joint replacement when compared to whites and Hispanics, binding of proteoglycans to hyaluronic acid, moderate inflammatory changes of synovium, osteophytes form through the pathologic activation of endochondral ossification mediated by the Indian hedgehog (Ihh) signaling molecule, responsible for cartilage matrix digestion, control MMP activity preventing excessive degradation, secreted by synoviocytes and increase MMP synthesis, No joint space narrowing (JSN) or reactive changes, Possible osteophytic lipping + doubtful JSN, Moderate osteophytes + definite JSN + some sclerosis + possible bone end deformity, Large osteophytes + marked JSN + severe sclerosis + definite bone end deformity, identify age, functional activity, pattern of arthritic involvement, overall health and duration of symptoms, often an increased adductor moment to the limb during gait, antalgic gait associated with knee arthritis, lack of full extension (>5 degrees flexion contracture), lack of full flexion (flexion <110 degrees), medial and/or lateral tibiofemoral, and/or patellofemoral, cartilage destruction with eburnation of subchondral bone, first line treatment for all patients with symptomatic arthritis, Non-steroidal anti-inflammatory drugs (first choice), selection should be based on physician preference, patient acceptability and cost, duration of treatment based on effectiveness, side-effects and past medical history, treatment option for patients with symptomatic arthritis, good evidence for mid term (8-13 weeks) improvement in pain and stiffness over placebo, Prior AAOS guidelines recommended its use, but newer guidelines do NOT recommend its routine use, rehabilitation, education and wellness activity, combination of supervised exercises and home program have shown the best results, these benefits lost after 6 months if exercises are stopped, patients with symptomatic arthritis and BMI > 25, medial unloader for isolated medial compartment OA, AAOS guidelines: moderate evidence against, younger patients with medial unicompartmental OA, valgus producing proximal tibial oseotomy, TKA have lower revision rates than UKA in the setting of unicompartmental OA, cruciate retaining vs. crucitate sacrificing implants show no difference in outcomes, no difference in pain or function with or without patella resurfacing, Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. Understanding the anatomic landmarks and capsular extensions of the major joints is key to proper evaluation. 12.19352 1 Td 454 0 l Suprapatellar nailing of tibial fractures: surgical hints : Current Ankle Arthroscopy - Foot & Ankle - Orthobullets Cards published by our editorial team or personal cards created by our users. q 1 0 0 1 72 471 cm 107 0 obj Q Initial evaluation of periarticular wounds includes thorough examination of the wound and plain radiographs. (Detection of Traumatic Arthrotomy of the Knee Using the Saline)Tj Injury. 99 0 obj Knee Arthroscopy - Approaches - Orthobullets Shoulder Approaches Humerus Approaches Elbow Approaches Forearm & Wrist Approaches Hand Approaches Acetabulum Approaches Hip Approaches Thoracic Spine Lumbar Spine Updated: Aug 2 2018 Knee Arthroscopy } David Abbasi MD Bullets 91 Questions 2 Cases 1 Evidence 5 Video/Pods 2 4.8 ( 16 ) 2 Topic Podcast The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation. Knee & Sports Pediatrics Recon Hand Foot & Ankle Pathology Basic Science Anatomy TECHNIQUES Trauma Spine Shoulder & Elbow Knee & Sports Pediatrics Recon Hand Foot & Ankle Pathology Approaches FEATURES Cards QBank Cases Topics Evidence Posts Videos Events PEAK & Study Plans PASS Self-Assessment Exam POCL FREE CME Price Chart endobj evaluation for traumatic arthrotomy of the knee Treatment Nonoperative urgent IV antibiotics, tetanus prophylaxis, and extremity stabilization and dressing indications initial treatment for all open fractures a soft tissue wound in proximity to a fracture should be treated as an open fracture until proven otherwise
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