58.32 Burnt bones and joints

The tibia, the ulna, and the skull are often burnt when an epileptic falls into the fire. If the tissues over his periosteum are burnt, it dies, and so does the bone under it, even if it escaped being burnt directly. As the slough falls away you may see greyish yellow bone protruding from among pink granulations round the edge of the burn. Granulations don’t form on dead bone, although they sometimes form under it as it separates, so speed up this process by chiseling it away.

BURNT BONES AND JOINTS

As soon as you see that a patient’s bone is dead, chisel it away, until you see some bleeding which shows that you have reached living bone. Wait for granulations to form, usually in 5 to 10 days. Then apply split skin grafts.

If a patient’s skull has been burnt, its outer table is usually dead. Chisel this away, and graft the granulations that form on the inner table. If the whole thickness of his skull has been burnt, graft his dura.

If a burnt joint becomes infected and pus pours from it, nibble away its articular cartilage and let an arthrodesis form in the position of function (7-16). If it does not fuse spontaneously, refer the patient for a formal arthrodesis; this may require the use of a compression clamp.

If an amputation is necessary, graft the stump.