Open joint injuries. Classification and treatment.

Experience with wounds involving the major joints of the lower extremity suggests that the extracapsular soft tissues and the intracapsular structures should be considered individually to assess accurately the magnitude of injury and to provide a prognosis. A classification scheme is proposed to characterize the areas and types of injury. Type I open joint injuries are single penetrations without extensive soft-tissue damage, permitting uncomplicated joint and wound closure. Type II injuries are single or multiple penetrations with extensive soft-tissue disruptions (flaps, avulsions, degloving), often requiring secondary operations to attain closure. Type III injuries are open periarticular fractures with extension through the adjacent intraarticular surface. Type IV injuries are open dislocations or those with associated nerve or vascular injury requiring repair. The extent of intraarticular injury further subdivides Types I, II, and III. The prognosis for functional impairment correlates with the severity of injury. The cornerstones for successful management are debridement, antibiotic therapy, properly timed and performed joint closure, and aggressive treatment of the associated bony injury.