Knee Puncture Wound: An Evidence-Based Approach to Management

21.09.202323.06.2023 by alexxlab

What are the causes and complications of knee puncture wounds?. How can they be prevented and treated effectively?.

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Understanding Knee Puncture Wounds

A knee puncture wound is a deep injury that occurs when a sharp, pointed object penetrates the skin and underlying structures of the knee joint. These types of wounds can happen due to a variety of causes, including falls, accidents, and stepping on sharp objects. Proper management of knee puncture wounds is crucial, as they can easily become infected and lead to serious complications if not treated promptly and effectively.

Causes and Complications of Knee Puncture Wounds

The most common causes of knee puncture wounds include:

Falling onto a sharp object, such as a nail or piece of glass
Stepping on a sharp object, such as a tack or piece of metal
Animal bites, especially from pets or wild animals
Accidents involving sharp tools or machinery

Complications of knee puncture wounds can include:

Infection, which can lead to further complications such as sepsis or osteomyelitis (bone infection)
Damage to the underlying structures, such as tendons, ligaments, or bone
Joint instability or decreased range of motion
Persistent pain and swelling

Prevention of Knee Puncture Wounds

To prevent knee puncture wounds, it’s important to be aware of your surroundings and take precautions when working with sharp objects or engaging in activities that could lead to falls or other injuries. Some key prevention strategies include:

Wearing appropriate protective gear, such as sturdy shoes, when working with or around sharp objects
Keeping work areas and walkways free of debris and sharp objects
Exercising caution and being aware of your surroundings when engaging in physical activities or sports
Promptly cleaning and treating any minor cuts or scratches to prevent infection

Evidence-Based Treatment Approach

The management of knee puncture wounds should follow an evidence-based approach to ensure the best possible outcomes for the patient. This approach typically involves the following steps:

Immediate first aid: Stop any bleeding by applying pressure to the wound, and clean the area thoroughly with soap and water or an antiseptic solution.
Wound assessment: Determine the depth and extent of the injury, and check for any foreign objects or debris that may be embedded in the wound.
Antibiotic prophylaxis: Administer appropriate antibiotics, either topically or systemically, to prevent infection.
Wound closure: If necessary, close the wound using sutures, staples, or other wound closure techniques.
Immobilization and joint protection: Immobilize the knee joint to prevent further injury and allow for proper healing.
Follow-up care: Regular monitoring and assessment of the wound, as well as any necessary physical therapy or rehabilitation, to ensure a full recovery.

Importance of Prompt Medical Attention

It’s important to seek prompt medical attention for any knee puncture wound, even if it appears minor. Failure to do so can lead to serious complications, such as joint infection or long-term functional impairment. Patients should be advised to seek immediate medical care if they experience any of the following signs or symptoms:

Excessive bleeding that cannot be controlled
Significant pain or swelling in the knee joint
Signs of infection, such as redness, warmth, or drainage from the wound site
Decreased range of motion or instability in the knee joint

Conclusion

Knee puncture wounds are serious injuries that require prompt and effective management to prevent complications and ensure a full recovery. By understanding the causes and potential complications of these injuries, and following an evidence-based approach to treatment, healthcare providers can help patients achieve the best possible outcomes. Regular patient education and awareness of preventive measures can also play a key role in reducing the incidence of knee puncture wounds and promoting overall joint health.

Cuts and Puncture Wounds: Causes, Complications, and Prevention

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Medically reviewed by William Morrison, M. D. — By April Kahn — Updated on November 1, 2019

A cut, or laceration, is a tear or opening in the skin that occurs due to an external injury. It can be superficial, affecting only the surface of your skin or deep enough to involve:

tendons
muscles
ligaments
bones

A puncture wound is a deep wound that occurs due to something sharp and pointed, such as a nail. The opening on the skin is small, and the puncture wound may not bleed much. Puncture wounds can easily become infected. A doctor should always examine a deep puncture wound. Puncture wounds that occur due to a bite or stepping on a rusty piece of metal, such as a nail, need prompt medical attention.

A cut can cause external and internal bleeding. A significant cut can cause profuse bleeding if it isn’t treated promptly and properly. Cuts and puncture wounds that cause excessive blood loss or those that damage the organs can be fatal.

The most common causes of cuts and puncture wounds are external injuries that break or tear the skin. These causes include:

falls
car accidents
broken glass
stabbings
razor cuts

The most common causes for puncture wounds include:

stepping on a sharp object, such as a nail
getting bitten
falling onto something sharp

Although puncture wounds don’t normally bleed heavily, they’re prone to infection. This is especially true if a bite or a rusty object caused the wound. See your doctor immediately if this is the case.

Cuts or puncture wounds that are minor may be treated at home. For more severe cuts or puncture wounds, immediate medical attention is necessary.

Cuts

First, stop any bleeding by covering the cut and applying gentle pressure. If the cut is bleeding heavily and you aren’t able to stop it, seek medical treatment immediately.

Next, clean the cut thoroughly with an alcohol wipe, antiseptic wash, or clean water. Dip a cotton swab into hydrogen peroxide and lightly roll it over the area of the cut to clean it. Use tweezers that have been cleaned with alcohol to remove debris on the surface of the cut. If you see debris embedded in the cut, don’t attempt to remove it. Seek help from your doctor or go to the nearest emergency room.

Once the cut has been cleaned, apply an antibiotic cream to it. This can prevent infection and speed the healing process. Apply a bandage to the cut site. Change the bandage daily and whenever it becomes wet or dirty.

Deeper cuts may require medical treatment. Treatment options for deep cuts include stitches, staples, or liquid stitches.

You may also need to take antibiotics to prevent infection.

Puncture wounds

First, attempt to stop the bleeding by covering the wound with a clean bandage and applying gentle pressure. If the wound is bleeding heavily and you cannot stop it, immediately seek emergency medical care.

Next, clean the area thoroughly using a small alcohol wipe. Don’t attempt to wash a puncture wound. If you notice debris embedded into the puncture wound, don’t try to remove it. Don’t probe the wound if you realize part of the object that caused the wound has broken off. Instead, seek emergency medical attention immediately.

Once the skin is clean, apply an over-the-counter antibiotic cream to prevent infection. Cover the puncture wound with a bandage. You should change the bandage daily or sooner if it becomes wet or dirty. Check for signs of infection, such as:

redness
drainage, such as pus, from the wound site
warmth or swelling in the surrounding area

Although most minor puncture wounds and cuts heal without treatment beyond first aid and home care, some should receive immediate medical attention. Seek emergency medical care if you notice any of the following:

the bleeding is heavy, spurting, or doesn’t stop after 10 minutes of applying pressure
feeling and function are impaired in the area of the cut or wound
muscle, tendon, or bone is exposed

Contact your doctor immediately if:

debris is embedded in the cut or wound
the cut or wound occurred due to a bite
you haven’t had a tetanus shot in 10 years
you stepped on an object, such as a nail
the cut or wound occurred due to a fish hook
the cut or wound shows the symptoms of infection, such as swelling around the site, throbbing pain, or fluid leaking from the cut or wound

Your doctor may suggest you get a tetanus vaccine.

Possible complications from a cut or puncture wound include:

a wound infection
a blood infection, or sepsis
gangrene
an amputation
a loss of function in the area of the wound
nerve damage
organ damage

Prevent cuts and puncture wounds by taking the following steps to ensure your physical safety:

Don’t play sports without using proper protective gear.
Wear shoes and make sure the soles are sturdy and cannot be punctured by a nail.
Don’t use heavy machinery or tools without wearing proper safety equipment and shoes.
After an accident, quickly clear away debris, such as broken glass.
Dry up spills, especially on slippery surfaces, before running or walking over the surface.

Last medically reviewed on October 31, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Checking out cuts, scratches, and abrasions. (2015, January)
kidshealth.org/kid/watch/er/cuts.html
First aid: Cuts, scrapes, and stitches. (2010, December)
familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/first-aid-cuts-scrapes-and-stitches.html
Mayo Clinic Staff. (2016, July 23). Cuts and scrapes
mayoclinic.com/health/first-aid-cuts/FA00042
Mayo Clinic Staff. (2015, February 4). Puncture wounds: First aid
mayoclinic.com/health/first-aid-puncture-wounds/FA00014

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Medically reviewed by William Morrison, M.D. — By April Kahn — Updated on November 1, 2019

Puncture wound without foreign body, left knee, initial encounter

ICD-10-CM Codes

›

S00-T88

›

S80-S89

›

S81-

›

2023 ICD-10-CM Diagnosis Code S81.032A

Puncture wound without foreign body, left knee, initial encounter

2016 2017 2018 2019 2020 2021 2022 2023 Billable/Specific Code

S81.032A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

Short description: Puncture wound without foreign body, left knee, init encntr

The 2023 edition of ICD-10-CM S81.032A became effective on October 1, 2022.

This is the American ICD-10-CM version of S81. 032A – other international versions of ICD-10 S81.032A may differ.

The following code(s) above S81.032A contain annotation back-references

Annotation Back-References

In this context, annotation back-references refer to codes that contain:

Applicable To annotations, or
Code Also annotations, or
Code First annotations, or
Excludes1 annotations, or
Excludes2 annotations, or
Includes annotations, or
Note annotations, or
Use Additional annotations

that may be applicable to S81.032A:

S00-T88
2023 ICD-10-CM Range S00-T88
Injury, poisoning and certain other consequences of external causesNote
- Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
Type 1 Excludes
- birth trauma (P10-P15)
- obstetric trauma (O70-O71)
Use Additional
- code to identify any retained foreign body, if applicable (Z18. -)
Injury, poisoning and certain other consequences of external causes
S80-S89
2023 ICD-10-CM Range S80-S89
Injuries to the knee and lower legType 2 Excludes
- burns and corrosions (T20-T32)
- frostbite (T33-T34)
- injuries of ankle and foot, except fracture of ankle and malleolus (S90-S99)
- insect bite or sting, venomous (T63.4)
Injuries to the knee and lower leg
S81
ICD-10-CM Diagnosis Code S81
Open wound of knee and lower leg
Code Also
- any associated wound infection
Type 1 Excludes
- open fracture of knee and lower leg (S82.-)
- traumatic amputation of lower leg (S88.-)
Type 2 Excludes
- open wound of ankle and foot (S91.-)
Open wound of knee and lower leg

Approximate Synonyms

Puncture wound of left knee

ICD-10-CM S81. 032A is grouped within Diagnostic Related Group(s) (MS-DRG v40.0):

604 Trauma to the skin, subcutaneous tissue and breast with mcc

605 Trauma to the skin, subcutaneous tissue and breast without mcc

963 Other multiple significant trauma with mcc

964 Other multiple significant trauma with cc

965 Other multiple significant trauma without cc/mcc

Convert S81.032A to ICD-9-CM

Code History

2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)

2017 (effective 10/1/2016): No change

2018 (effective 10/1/2017): No change

2019 (effective 10/1/2018): No change

2020 (effective 10/1/2019): No change

2021 (effective 10/1/2020): No change

2022 (effective 10/1/2021): No change

2023 (effective 10/1/2022): No change

ICD-10-CM Codes Adjacent To S81. 032A

S81.029 Laceration with foreign body, unspecified knee

S81.029A …… initial encounter

S81.029D …… subsequent encounter

S81. 029S …… sequela

S81.03 Puncture wound without foreign body of knee

S81.031 Puncture wound without foreign body, right knee

S81.031A …… initial encounter

S81. 031D …… subsequent encounter

S81.031S …… sequela

S81.032 Puncture wound without foreign body, left knee

S81.032A
…… initial encounter

S81. 032D …… subsequent encounter

S81.032S …… sequela

S81.039 Puncture wound without foreign body, unspecified knee

S81.039A …… initial encounter

S81. 039D …… subsequent encounter

S81.039S …… sequela

S81.04 Puncture wound with foreign body of knee

S81.041 Puncture wound with foreign body, right knee

S81. 041A …… initial encounter

S81.041D …… subsequent encounter

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Incised wound – causes, symptoms, diagnosis and treatment

Incised wound is a wound caused by a sharp object (razor, blade, knife). It has sharp corners, smooth edges and a linear shape, bleeds heavily, gapes. The length of the wound channel prevails over its width. It can be superficial or accompanied by damage to muscles, nerves, blood vessels and internal organs. With timely adequate treatment, it is the most favorable in terms of healing. The damage is caused by accidents at home or at work, as well as criminal incidents. The diagnosis is exposed on the basis of the anamnesis and clinical symptoms. Surgical treatment.

General information

Incised wound – a wound caused by a cutting tool with a small weight and a sharp blade (razor, knife, scalpel, less often – a piece of glass or a pointed piece of metal). Treatment of superficial incised wounds, as well as wounds with damage to small and medium-sized vessels and nerves, is carried out by traumatologists. Vascular surgeons deal with wounds with damage to large vessels, neurosurgeons with damage to large nerve trunks, and thoracic surgeons, abdominal surgeons or urologists with damage to internal organs.

Cut wound

Causes

Cut wounds are caused by accidents at home or at work, as well as criminal incidents. It is mainly detected in people of working age, men suffer more often than women, which is due to both higher physical activity in the implementation of professional or domestic activities, and a higher likelihood of participating in criminal incidents. Wounds received as a result of an accident are usually single. In criminal incidents, both single and multiple injuries occur.

Pathogenesis

The wound is formed by sliding and pressure of a sharp blade. Characteristic features are rectilinear direction, spindle-shaped wound, predominance of length over depth and width, wedge-shaped section (at the edges the depth of the wound channel is less than in the center), smooth and even edges and profuse bleeding. The degree of straightness of the wound depends on the shape of the blade and the direction of its movement in relation to the tissues.

Linear-arched wounds may form on the rounded part of the body. Raised or wrinkled skin sometimes results in zigzag or jagged cut wounds. On contact with bone or defensive movement of the victim, the direction of the incision may change. Due to the elasticity of the tissue on the sides of the wound, they contract, so a spindle-shaped cut (an oval with pointed corners) occurs at the site of a rectilinear incision.

The degree of divergence of the edges depends on the direction of the incision in relation to the direction of the muscles and elastic fibers. If the incised wound, muscles and elastic fibers are located parallel to each other – the gaping is insignificant, if it is perpendicular – the edges of the cut gape widely. At the same time, even with a significant gaping, the corners of the wound remain sharp. The evenness and smoothness of the incision edges, as well as the minimum amount of damaged tissues in the walls of the wound channel, are due to the sharpness of the blade.

Symptoms of a cut wound

Examination reveals a violation of the integrity of the skin and underlying tissues. Cut wounds in most cases bleed heavily, which is explained by unfavorable conditions for the formation of blood clots in comparison with chopped and, especially, bruised or crushed wounds. The severity and outcome of blood loss are determined by many factors, including the type of damaged vessels (arteries, veins, capillaries), the rate and volume of blood loss, the general condition of the patient’s body, his gender and age, as well as environmental conditions.

In case of accidents at work or at home, incised wounds of the hands predominate. When attempting suicide, cuts in the absolute majority of cases are located on the inside of the forearm, rarely – in the area of the elbow bend or along the anterior inner surface of the thigh. Wounds inflicted during criminal incidents are more often localized in the region of the anterior abdominal wall, chest, as well as the anterior and lateral surfaces of the neck. For protective wounds, the location is characteristic on the back and ulnar (from the side of the little finger) side of the forearm.

Most wounds do not penetrate deeper than the skin and subcutaneous tissue. However, when using a very sharp tool and applying great force, damage to deeply located anatomical structures is possible. Especially dangerous are wounds with vascular damage (intense external bleeding, a high probability of blood loss and the development of hypovolemic shock), damage to the nerves (disturbances in sensitivity, paresis and paralysis) and internal organs (massive internal bleeding, a high probability of developing traumatic shock and severe complications, such as peritonitis). with damage to the abdominal organs). Cartilage and periosteum are rarely damaged, the integrity of the bones is almost never violated.

Diagnostics

The scope of the examination upon admission to the emergency room or the Department of Traumatology and Orthopedics depends on the characteristics and location of the incised wound. For superficial lesions with a visible bottom of the wound, a visual inspection is sufficient. If damage to a large vessel is suspected, the pulse on the peripheral arteries is examined, and a consultation with a vascular surgeon is prescribed. If nerve damage is suspected, sensitivity and movement are assessed, a consultation with a neurosurgeon or neurologist is prescribed, and if necessary, electromyography and other studies are performed. Damage to hazardous areas (chest, abdominal wall, lumbar region, etc.) may require chest x-ray, MRI, ultrasound, arthroscopy, laparoscopy, and other studies.

Treatment of an incised wound

Wash the wound with running water. The skin around the cut is cleaned using a gauze pad, the edges of the wound are treated with an antiseptic, and then the incision is closed with an aseptic dressing. With abundant capillary or venous bleeding, a pressure bandage is used. In case of arterial bleeding, a tourniquet is applied to the shoulder or thigh (imposing a tourniquet on the forearm and lower leg is irrational even if the wound is low). The patient in all cases, including relatively small cuts without profuse bleeding, should be taken to a medical facility as soon as possible, since early treatment reduces the number of infectious complications.

Incised wounds less than a day old, in the absence of signs of inflammation, are subject to primary surgical treatment. Depending on the location and size of the injury, PST can be performed under local anesthesia or general anesthesia. The wound is abundantly washed with a solution of peroxide and furacilin, examined for damage to muscles, tendons, nerves and blood vessels. In the presence of damage, the muscles are sutured with catgut, primary sutures are applied to the tendons (only if the injury is not more than 6 hours old), small vessels are tied up, and the nerves are sutured.

The walls and edges are excised, the wound is washed again with peroxide and furatsilin, sutured in layers and drained using a rubber outlet, a half-tube or a tube with a pear. If necessary (in case of damage to large muscles, tendons, etc.), the limb is immobilized with a plastic or plaster splint. After the operation, painkillers and antibiotics are prescribed, dressings are performed. Drainage is removed for 2-3 days. With a favorable course, the wound heals for 7-10 days, after which the doctor removes the stitches. Further tactics of treatment and rehabilitation depend on the presence or absence of damage to the tendons, muscles and other anatomical structures.

Tactics of conservative measures is determined by the patient’s condition and the amount of blood loss. With a loss of less than 1 liter, systolic pressure of more than 90 mm Hg. Art. and pulse less than 100 beats / min intravenous infusions are not required. With a blood loss of less than 1 liter, in combination with a lower pressure and a frequent pulse, as well as with a blood loss of up to 1.5 liters, blood and plasma substitutes are transfused. In case of severe and massive blood loss, large doses of plasma substitutes, blood and various solutions are transfused. During treatment, diuresis is monitored, if necessary, stimulation with furosemide and aminophylline is carried out.

Incised wounds more than a day old are not stitched, such injuries heal by repeated tension. The wound is washed regularly, drained if necessary, purulent streaks are opened, etc. The patient is prescribed analgesics and antibiotics. The recovery time depends on the characteristics of the injury and the severity of the purulent process. All operations to restore tendons, nerves and blood vessels are carried out in a planned manner, after complete healing of the wound.

In case of damage to internal organs, appropriate surgical interventions are performed: in case of damage to the lung – thoracotomy, in case of damage to the abdominal organs – laparotomy, etc. The extent of the operation is determined taking into account the degree of destruction of an organ, usually with incised wounds it is possible to carry out organ-preserving interventions ( suturing of the organ or resection of its part). The surgical incision is sutured in layers and drained. In the postoperative period, antibiotics and analgesics are prescribed, dressings are performed.

Prognosis and prevention

The prognosis for incised wounds depends on their location, duration of injury, amount of blood loss, presence or absence of damage to internal organs, blood vessels, nerves and tendons, as well as on the general condition of the patient’s body, concomitant injuries and somatic diseases. In most cases, fresh incised wounds heal by first intention.

It should be borne in mind that some diseases (for example, diabetes mellitus) negatively affect the course of the wound process and can cause extensive suppuration even due to scratches or small cuts, therefore, in such cases, especially careful observation is required, careful observance of aseptic and antiseptic rules and special treatment measures. Prevention consists in taking measures to reduce the level of injuries.

why it is dangerous – “Sensitive”

Any stab, chopped, lacerated and incised wound can be complicated by the process of suppuration. Even if you cut your finger with a knife in the kitchen, you should not think that this is a trifle, because an insufficiently treated wound can fester. The first symptoms of wound suppuration should be known to everyone for the reason that in most cases this problem has to be solved exclusively by surgery.

This problem is especially relevant for those who have undergone some kind of surgery and have been discharged home after rehabilitation. If the postoperative sutures are not cared for at home as prescribed by the doctor, then, if an infection enters, suppuration may begin. Contrary to the generally accepted opinion of patients, suppuration after surgery does not begin due to the conditions during the operation, but precisely through the fault of patients who irresponsibly approach the doctor’s prescriptions when they are at home.

Absolute sterility is essential during the operation, and this principle is never violated. The doctors of the Yeisk Medical Center “Sensitive” recommend that you always fully comply with the appointments that they make in order to avoid such serious complications.

How the process of wound suppuration develops

Usually, suppuration begins when a clean wound becomes infected, edema develops around the wound, tissue necrosis and purulent discharge appears. If redness has begun around the wound, which is accompanied by jerking pain that worsens at night, then this means that you are dealing with the first symptom of suppuration of the wound, and urgent measures are required.

Examination of the wound shows dead tissue, pus discharge. The situation is dangerous because the decay products are absorbed by the body, and this leads to increasing intoxication of the body. As a result, the following symptoms appear:

a significant increase in temperature;
chills;
headache;
weakness;
nausea.

Causes of festering wounds

Any wound, small or large, is considered infected, because bacteria enter it anyway. However, this does not always lead to suppuration. In order for this destructive process of tissues to develop, additional conditions are required:

sufficient tissue damage;
the presence of non-viable tissues in the wound cavity;
the presence of foreign bodies in the wound cavity;
the presence in the cavity of the wound of the outflow of blood;
high concentration of pathogens.

Therefore, the first symptoms of wound suppuration may appear even after a common splinter, provided that its particle remains in the body tissue, and at the same time there are pathogenic microorganisms on the foreign body itself. The latter include those responsible for the development of the purulent process: staphylococci, streptococci, Escherichia coli and similar microorganisms.

In addition, there is a high risk of suppuration when the patient has a history of diabetes mellitus, vascular and somatic diseases, overweight and advanced age.

The nature of the wound is also important for the development of this process. So, a stab wound can fester due to a too narrow wound channel, due to which there is no normal outflow. In the case when the wound is accompanied by crushing of the surrounding tissues, suppuration occurs due to too much dead tissue in the wound and abundant contamination. At the same time, wounds on the head and neck heal faster and better, and worst of all – on the feet.

Treatment of wound suppuration

The first symptoms of wound suppuration should alert and make you see a doctor immediately, because there is a risk of serious complications that threaten life.

Knee Puncture Wound: An Evidence-Based Approach to Management

Understanding Knee Puncture Wounds

Causes and Complications of Knee Puncture Wounds

Prevention of Knee Puncture Wounds

Evidence-Based Treatment Approach

Importance of Prompt Medical Attention

Conclusion

Cuts and Puncture Wounds: Causes, Complications, and Prevention

Cuts

Puncture wounds

How we reviewed this article:

Read this next

Puncture wound without foreign body, left knee, initial encounter

Puncture wound without foreign body, left knee, initial encounter

Injury, poisoning and certain other consequences of external causesNote

Injuries to the knee and lower legType 2 Excludes

Open wound of knee and lower leg

Incised wound – causes, symptoms, diagnosis and treatment

General information

Causes

Pathogenesis

Symptoms of a cut wound

Diagnostics

Treatment of an incised wound

Prognosis and prevention

why it is dangerous – “Sensitive”

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