GUNSHOT INJURIES TO THE JOINTS

The essentials in the treatment of gunshot injuries of joints seem to us to be the following, given in the order of their importance.

1. Fixation and traction provided at the earliest possible moment by thoroughly efficient splints and continued in transport till a hospital is reached, at which the patient may remain until convalescence from a possible operation is sufficiently well advanced to allow safe further transport (in all probability two or three weeks).

2. Early careful examination, radiographic, bacteriological, and clinical, at the earliest possible moment after the injury. This examination must be carried out by a specially trained surgeon capable of operating skillfully and at once, and at a well-equipped hospital, not far from the line, where the patient may remain under the close observation of this surgeon or his qualified assistants until convalescence is well established.

3. Primary, delayed primary, or secondary closure of the wound in all operative cases by a special technique now sufficiently well established to be regularly followed, which in the secondary closures involves a thorough knowledge of the Carrel-Dakin method.

4. After-treatment to assure most perfect function, consisting of early active motion. Later massage, possibly electrical and hydrotherapeutic treatment, often in conjunction with special orthopedic apparatus, and curative occupational therapy.

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