ACTA FAC MED NAISS 2013;30(4):225-231

Case report

UDC: 616.728.3-001-089

DOI: 10.2478/afmnai-2013-0015

Missile Injury of the Knee Joint

Zoran Golubović^1,4, Zoran Popović², Saša Milenković^1,4, Predrag Stojiljković¹, Goran Stevanović^3,4, Zoran Radovanović^4,5, Ivan Golubović¹, Milan Trenkić^3,4, Stevo Najman⁴, Slađana Petrović^4,5

¹Clinic of Orthopaedics and Traumatology, Clinical Center Niš, Serbia

²Clinic of Orthopaedics and Traumatology, Military Medical Academy, Belgrade, Serbia

³Clinic od Plastic and Reconstructive Surgery, Clinical Center Niš, Serbia

⁴University of Niš, Faculty of Medicine, Niš, Serbia

⁵Center for Radiology, Clinical Center Niš, Serbia


summary

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.

Key words: missile injuries of the knee, surgical treatment of wound, knee arthroscopy