Gun-shot injuries
Gun-shot injuries of joints vary in severity from a mere puncture of the synovial layer by a chip of shell to complete shattering of the articular surfaces. Between these extremes are cases in which the capsular and synovial layer are extensively lacerated without involvement of the bones, and others in which the bones are implicated without serious damage being done to ligaments or synovial layer—for example, by a bullet passing through and through the cancellated part of one of the constituent bones, or by a fissure extending into the articular surface.
In all degrees the great risk is from septic infection, which may be assumed to be present in all but the last-named variety.
The treatment consists in immediately cleansing the wound by excising grossly damaged tissue and removing any foreign body that may have lodged; disinfecting the exposed part of the joint cavity with eusol, “bipp,” or other antiseptic, and closing the wound or establishing drainage, according to circumstances. The joint is then immobilised till the wound has healed, after which massage and movement are commenced. When the bones are shattered or when sepsis gets the upper hand and disorganises the joint, amputation is called for.
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