Opioid of choice (e.g. fentanyl 50 mcg IV)
Initial immobilization as needed
Orthopedic "Golden 6 hours" – applies similarly to<unk>  fractures. Treat <6 hours with surgical debridement and washout
Can irrigate grossly contaminated wounds in ED
Tetanus prophylaxis
Depends on concern for infection (similar to<unk>  fractures)
Staph/strep coverage – 1st generation cephalosporin (cefazolin 2g IV TID)
If more contaminated – add anaerobic coverage (gentamicin 300mg IV)
Very contaminated/farm contamination – concern for clostridial infection (piperacillin/tazobactam 4.5 g q8 hrs)
Seawater contamination – concern for vibrio vulnificus (doxycycline)
Open joint injury
Compartment syndrome
Open fracture
Contusion
Acute knee injury
Crush syndrome
Knee fractures
Degloving injury