THE MANAGEMENT OF PENETRATING WOUNDS AND SUPPURATIVE ARTHRITIS OF THE KNEE JOINT IN THE MEDITERRANEAN THEATER OF OPERATIONS

¹ Medical Corps, Army of the United States

1. At the time of the initial surgical treatment, the preferred plan of management for penetrating wounds of the knee joint—regardless of the time interval between receiving the wound and operation—should include arthrotomy; excision of the devitalized tissue, including areas of destroyed articular cartilage; cleansing of the blood clot and debris from the joint; suture of the synovial membrane or capsule; and immobilization of the limb in a hip spica or a Tobruk splint.

2. At the time of reparative surgery, preferably from five to ten days after the intra-articular surgery, the skin should be sutured.

3. Immobilization should be discontinued as soon as the danger of sepsis is past and the skin has healed, or is healing. Active and passive mobilization should then be instituted.

4. In cases of suppurative arthritis of the knee joint, potential or established, the same surgical plan is indicated.

5. Continuous drainage of fluid from the knee joint is not adequate surgical treatment in cases of suppurative arthritis; moreover, it is not indicated.

6. Systemic penicillin (at present the best available antibacterial agent), supplemented by the local instillation of penicillin into the joint, should be employed in patients with wounds and suppurative arthritis of the knee joint, in order to prevent invasive infection of the living tissue.

7. In the light of the problem and the hazards of knee-joint sepsis, knee-joint resection has a definite, but fortunately a limited, application in the management of severe wounds and sepsis of the knee joint in military surgery.

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