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ounding tissues. The most prominent _clinical features_ are swelling and discoloration. The swelling, especially in superficially placed joints, is an early and marked symptom, and is mainly due to the effusion of blood into the joint (_haemarthrosis_). In deeply placed joints, discoloration may not appear on the surface for some days, especially if the violence has been indirect. The joint is kept in the flexed position, and is painful only when moved. In haemophilic subjects, considerable effusion of blood into a joint may follow the most trivial injury. A slight degree of serous effusion into the joint (_hydrarthrosis_) often persists for some time, and tuberculous affections of joints not infrequently date from a contusion. The _treatment_ is the same as for sprains (p. 36). #Wounds of Joints.#--The importance of accidental wounds of joints--such, for example, as result from a stab with a penknife or the spike of a railing--lies in the fact that they are liable to be followed by infection of the synovial cavity. The infection may involve only the synovial layer (_septic synovitis_), or may spread to all the elements of the joint (_septic arthritis_). These conditions are described with diseases of joints. Penetration of the joint may sometimes be recognised by the escape of synovia from the wound, or the synovial layer or articular cartilage may be exposed. When doubt exists, the wound should be enlarged. The use of the probe is to be avoided, on account of the risk of carrying infective material from the track of the wound into the joint. Penetrating wounds of joints are treated on the same lines as compound fractures. If the penetrating instrument is to be regarded as infected,--as, for example, when the spoke of a motor bicycle is driven through the upper pouch of the knee,--the injury is to be looked upon as serious and capable of endangering the function of the joint, loss of the limb, or even life itself. Reliance is chiefly laid on primary excision of the edges and track of the wound, and other measures employed in the treatment of gun-shot wounds. While the wound in the synovialis and capsule is sutured, that in the soft parts is left open. If drainage is employed, the tube extends down to the opening in the synovialis, but not into the joint itself. If sepsis supervenes, the joint is opened and irrigated by Carrel's method. Some form of splint and a Bier's bandage are valuable adjuncts. The fina
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