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With all lacerations, injury to the local vasculature must always be considered
to prevent significant sequelae. The evaluation for vascular injury should start
with a complete evaluation of pulses. Depending on the wound location, this
might include the femoral, popliteal, dorsalis pedis, posterior tibial, axillary,
radial, and ulnar pulses. When evaluating for the presence and quality of pulses, it
is important to compare the injured side to the noninjured side for asymmetry.
Signs of arterial injury include hemorrhage, hematoma, bruit over the wound,
absent distal pulses, and signs of ischemia (pallor, pain, coolness).
If there is concern for vascular injury, a surgical consultation should take place.
The next step in evaluation may direct exploration in the operating room or
imaging such as an arteriograph or CT angiogram.

LACERATIONS IN PROXIMITY TO JOINTS
CLINICAL PEARLS AND PITFALLS
Keep a high index of suspicion of possible joint cavity violation when
evaluating large wounds in close proximity to large joints such as the
knee, elbow, and ankle.
Orthopedic consultation is required when there is concern for joint
violation.
Fluid seepage or “sucking” sound during clinical examination should
raise concern immediately.
Use 3-0 nonabsorbable sutures for noncommunicating lacerations over
large joints and consider splinting the extremity to avoid wound
dehiscence.
Lacerations that occur near joints need special consideration (see Chapters 42
Injury: Knee and 111 Musculoskeletal Trauma ). These most commonly include
lacerations near the knee, elbow, or ankle. With even minor lacerations, there is
risk for developing septic arthritis if there is joint involvement. Indications that
the laceration may extend into the joint include fluid seepage, sucking wound
sound, palpable effusion, painful range of motion, and palpable capsular defect
with probing. If it is difficult to assess the penetration of the wound by clinical

examination, radiographs may be helpful. Concerning signs on x-ray may include
a joint effusion, foreign body near or in the joint, or air in the joint space. If there
is clinical suspicion for joint involvement, orthopedic consultation is advised to