Missile Injury of the Knee Joint

• Published in: Acta Facultatis Medicae Naissensis 2013-12, Vol.30 (4), p.225-231
• Main Authors: Golubović, Zoran, Popović, Zoran, Milenković, Saša, Stojiljković, Predrag, Stevanović, Goran, Radovanović, Zoran, Golubović, Ivan, Trenkić, Milan, Najman, Stevo, Petrović, Slađana
• Format: Article
• Language: English
• Subjects: artroskopija kolenog zgloba; knee arthroscopy; missile injuries of the knee; primarna hirurška obrada rane; surgical treatment of wound; ustrelna rana kolena
• ISSN: 2217-2521; 0351-6083; 2217-2521
• DOI: 10.2478/afmnai-2013-0015

Penetrating injuries of the knee joint are among the most difficult groups of bone - joint system injuries. They are characterized by extensive destruction of all anatomical structures of the knee joint. This paper presents two patients with penetrating wounds of the knee joint, of which one was injuried by shrapnel bomb, while another was wounded by a bullet from a gun. Both patients were treated by primary surgical treatment for penetrating wound of the joint. Arthroscopic surgery was performed in both patients to remove fragments of the bomb and bullet. Parenteral antibiotic and anti-tetanus therapy were administered in both patients. Surgical treatment of penetrating wound of the knee joint is a two-stage procedure. The first act is the primary surgical treatment of penetrating wound of the joint according to the principles of war wounds treatment. Primary surgical treatment of penetrating, gunshot wounds to the knee joint is usually from the surface to deeper layers of the wound and involves the removal of the entire non-vital, necrotic tissue. Excision of the joint capsule should be extremely sparing, but the whole damaged joint capsule must be removed. Only the joint synovial membrane can be closed primarily. If this is not possible, then the joint capsule should be closed. Other structures are left open for delayed primary closure. The second act is a delayed closure of penetrating gunshot wound of the joint. Arthroscopic removal of fragments from the knee joint is a useful method to prevent complications and infection after this injury.