An antiseptic powder composed of equal parts of boric acid and exsiccated alum is employed to protect the wound surfaces and the margins, and the parts are then bandaged.  In bandaging wounds of this kind a liberal amount of cotton should be employed, and after a large surface surrounding the wound has been thoroughly cleansed, it must be so kept thereafter.  This is impossible, if one uses a small amount of cotton, particularly if such meager quantity of dressing material is carelessly wrapped in position with an insufficient amount of bandage material.  Mention, without description of the elemental problem of applying cotton and bandages to a wound, would be sufficient, were it not that this is a very important part of the handling of such cases, and many practitioners are not only thoughtless in this part of their work, but also apparently careless.  What does it profit to prepare a part and cleanse a wound with painstaking care and then neglect to take every possible precaution to prevent its subsequent contamination?

In the handling of open joint capsules where the perforation of the capsular ligament is small and discharge of synovia does not immediately follow, there is presented a problem which is difficult to decide upon and that is the manner in which such wounds are to be handled.  One hesitates to enlarge such openings to drain or irrigate the capsule when there is no proof that serious trouble will follow because of infectious material which has probably been introduced at the time the wound was inflicted.  It is especially difficult to decide upon the manner of handling such cases where the tarsal joint is wounded, although one hesitates to invade any joint to the extent of incising its capsule, unless there is urgent need of so doing.

Frost[19] offers the following suggestion in such instances: 

The treatment recommended by us for open joints, in which we wish to prevent ankylosis, is, first, to shave all hair from the area surrounding the wound, following with a thorough cleansing of the skin and disinfection of the wound, and then to inject a twenty per cent Lugol’s solution in glycerin into the wound.  This should be repeated two or three times a day, each time enough of the solution being injected to fill the joint capsule, thereby securing the flushing effect.  As this solution does not cause irritation to the tissue and yet is a strong antiseptic, it serves to shorten the period of congestion and inflammation and to overcome the infection without causing a destruction of the secreting membrane until the external wound has had time to heal.  The injection of this solution seems to retard the excessive secretion of synovia.  The larger the joint capsule and the smaller the external wound, the longer our antiseptic will remain in contact with the inflamed tissues as the glycerin, being thick, does not flow through a small opening.

After-care.—­Following the initial cleansing