CHAPTER XII 



The Articulations 



TRAUMATIC LESIONS. 



Wounds of Joints. The joints of the extremities are most 

 subject to traumatic lesions. A joint may be merely punctured or 

 it may be laid freely open and complicated with injury Of the neigh- 

 boring structures. A joint wound is dangerous only if infected, 

 simple non-infected puncture wounds often healing by primary 

 intention, but the larger the wound the greater is the liability to 

 infective inflammation and suppuration. Should the inflammatory 

 process pursue a pernicious course, it terminates by destruction of 

 the joint and local ankylosis, if in the meantime pyemia does not 

 intervene. But if the cartilages escape destruction the usefulness of 

 the joint may not yet be destroyed. 



Symptoms and Diagnosis. A non-infected joint-wound gives 

 vent to a flow of synovia, which is recognized by its glairy appear- 

 ance. This fluid must not be confounded with that emanating from 

 an open tendon sheath with which it is very similar in appearance. 

 There is but little swelling or pain. When infection occurs, all 

 movements of the articulation are suppressed. The whole articula- 

 tion becomes tumefied and as the disease progresses, discharges a 

 grumous purulent matter. Collateral edema ensues, the function 

 of the member is totally suppressed, fever appears, the appetite fails 

 and the body emaciates. 



Treatment. All wounds of joints or of periarticular tissues 

 should receive thorough antiseptic irrigation with a sublimate solu- 

 tion (i : looo) the hair in the vicinity being removed. If infection 

 is not apparent, the lesion should be occluded with iodoformized 

 collodion and the region covered with an antiseptic bandage. When 

 infection has occurred, the joint must be laid freely open, irrigated 

 night and morning with the sublimate solution, protective bandages 

 being also applied. 



Sprains of Joints. By this term is meant an imcomplete rup- 



