Bunyasaranand John C, Foeger Nicholas C, Ryan Paul M
Graduate Medical Education, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Department of Orthopedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
BMJ Case Rep. 2017 Sep 27;2017:bcr-2017-221094. doi: 10.1136/bcr-2017-221094.
An 84-year-old man sustained a motorcycle accident resulting in a left elbow laceration. Orthopaedics was consulted to rule out traumatic arthrotomy. Radiographs and CT of the left elbow showed no acute osseous abnormalities and no evidence of traumatic arthrotomy. The wound was irrigated, dressed and splinted. On follow-up, the patient reported that he had been given clindamycin on a return visit to the emergency department for increased drainage. On inspection, the patient's wound was found sutured and draining purulent fluid. The patient persistently had no pain on axial loading or range of motion since his injury and no evidence of intra-articular air on initial CT. However, given the mechanism of injury, irrigation and debridement (I&D) in the operating room was immediately performed revealing purulent joint fluid and a traumatic arthrotomy. I&D was carried out for the second time in the joint. After an extended hospital stay and antibiotics, the infection resolved.
一名84岁男性遭遇摩托车事故，导致左肘部撕裂伤。咨询骨科以排除创伤性关节切开术。左肘部的X线片和CT显示无急性骨质异常，也没有创伤性关节切开术的证据。对伤口进行了冲洗、包扎和夹板固定。在随访中，患者报告称，他因引流增加返回急诊科就诊时被给予了克林霉素。检查发现患者的伤口已缝合且有脓性液体流出。自受伤以来，患者在轴向负荷或活动范围内一直没有疼痛，初始CT也没有关节内积气的证据。然而，鉴于损伤机制，立即在手术室进行了冲洗和清创术（I&D），发现脓性关节液和创伤性关节切开术。在关节内再次进行了冲洗和清创术。经过长时间住院和使用抗生素后，感染得到解决。
