puncture Wound

Question 1

Peak occurrence f wound

Answer 1

May to October ( barefoot months )

Question 2

most common object?

Answer 2

Needles

Question 3

Wound > 6 hrs

Answer 3

Higher probability of infections organisms

Question 4

Wound > 48 hrs

Answer 4

Greater risk of complications

Question 5

Tetnus

Answer 5

3x more common in diabetics

Question 6

Tetnus deaths

Answer 6

4x more common in diabetics

Question 7

When do you use antibiotic prophylaxis ?

Answer 7

Highly contaminated wounds

Delayed presentation wounds

Question 8

What antibiotics do use prophylaxis ?

Answer 8

1st generation cephalosporin

Question 9

What Ab do use for at risk wounds?

Answer 9

Augmentin

Bactrim

Question 10

What Ab do use for wounds through a wound ?

Answer 10

CIprofloxacin

Question 11

zone 1

Answer 11

metatarsal neck to distal phalanges

Highest risk of developing osteomyelitis

Question 12

zone 2

Answer 12

Distal aspect of the calcaneous to metatasal neck

second highest risk of developing osteomyelitis

Question 13

zone 3

Answer 13

Plantar aspect of calcaneus

Question 14

Signs of infected wound

Answer 14

Pain 
swelling
Erythema
Warmth
Decreased ROM
Drainage

Question 15

Infectious organisms

Answer 15

Gram +
Gram -
Pasteurella Multocida
Eikenella Corrodens

Question 16

Examples of gram +

Answer 16

staphylococcus

Streptococus ( most common due to being part of normal skin flora)

Question 17

Examples of Gram -

Answer 17

• Klebsiella
• E coli
• proteus mirabilis
• psudomonas aeruginosa ( puncture wound through a shoe , most commonly associated with osteomeylitis )
• Pasteurella Multocida ( dog bites )
• Eikenella corrodens ( human botes and toothpicks

Question 18

why do you use US?

Answer 18

to look for woods as it often goes undetected on plain radiographs

Question 19

Goals for tx:

Answer 19

• Remove offending object

- Convert contaminated wound into clean wound

Question 20

if you are unable to remove foreign body or you see signs of infection

Answer 20

Do Surgical debridement in OR