Advertisement
Journal of Shoulder and Elbow Surgery

Detection of traumatic elbow arthrotomies: computed tomography scan vs. saline load test

      Background

      Traumatic elbow arthrotomies are common injuries evaluated for by orthopedic services; however, failed identification of a traumatic arthrotomy leads to a high risk of developing septic arthritis. Currently these injuries are evaluated by either a saline load test or a computed tomography (CT) scan, yet there is little published evidence regarding detection of traumatic elbow arthrotomies.

      Hypothesis

      In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test.

      Study Design

      Descriptive cadaveric laboratory study.

      Methods

      Ten fresh-frozen cadaveric transhumeral upper extremity amputation specimens were thawed for trial. Specimens were brought through CT scan prior to arthrotomy, arthrotomy was made, and then post arthrotomy a repeat CT scan was performed. A saline load test was then performed after all CT scans were completed.

      Results

      Zero CT scans before (0/10) and after (0/10) the arthrotomies were positive for intra-articular air in the elbow joint with a 0% sensitivity and specificity. The saline load test had an average positive test at 19 mL with a 100% sensitivity and 100% specificity.

      Conclusion

      After our study and based on the recommendations of the brief literature on this topic, we advise evaluating for traumatic elbow arthrotomies with a saline load test as the primary method of detection.

      Level of evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Azar F.M.
        • Beaty J.H.
        • Canale S.T.
        13th ed. Campbell’s operative orthopedics. Lippincott Williams & Wilkins, Philadelphia, PA2017: 2662-2668
      1. (Beaumont Health.)
        • Biswas D.
        • Bible J.E.
        • Bohan M.
        • Simpson A.K.
        • Whang P.G.
        • Grauer J.N.
        Radiation exposure from musculoskeletal computed tomographic scans.
        J Bone Joint Surg Am. 2009; 91: 1882-1889https://doi.org/10.2106/JBJS.H.01199
        • Browning B.B.
        • Ventimiglia A.V.
        • Dixit A.
        • Illical E.
        • Urban W.P.
        • Jauregui J.J.
        Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature.
        Acta Orthop Traumatol Turc. 2016; 50: 597-600https://doi.org/10.1016/j.aott.2016.01.004
        • Bunyasaranand J.C.
        • Foeger N.C.
        • Ryan P.M.
        Traumatic elbow arthrotomy after motorcycle accident not evident on CT.
        BMJ Case Rep. 2017; 2017https://doi.org/10.1136/bcr-2017-221094
        • Camp C.L.
        • Degen R.M.
        • Sanchez-Sotelo J.
        • Altcheck D.W.
        • Dines J.S.
        Basics of elbow arthroscopy part I: surface anatomy, portals and structures at risk.
        Arthrosc Tech. 2016; 5: e1339-e1343https://doi.org/10.1016/j.eats.2016.08.019
        • Collins D.N.
        • Temple S.D.
        Open joint injuries: classification and treatment.
        Clin Orthop Relat Res. 1989; 243: 48-56
        • Feathers T.
        • Stinner D.
        • Kirk K.M.
        • Kirby J.
        • Hsu J.R.
        Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies.
        J Trauma. 2011; 71: E110-E113https://doi.org/10.1097/TA.0b013e3182127840
        • Hudson T.M.
        Elbow arthrography.
        Radiol Clin North Am. 1981; 19: 227-241
        • Johansson O.
        Capsular and ligament injuries of the elbow joint. A clinical and arthrographic study.
        Acta Chir Scand. 1962; : 1-159https://doi.org/10.1186/s12891-019-2726-6
        • Keese G.R.
        • Boody A.R.
        • Wongworawat M.D.
        • Jobe C.M.
        The accuracy of the saline load retention test in the diagnosis of traumatic knee arthrotomies.
        J Orthop Trauma. 2007; 21: 442-443https://doi.org/10.1097/BOT.0b013e31812e5186
        • Kinaci A.
        • Neuhaus V.
        • Ring D.
        Surgical procedures of the elbow: a nationwide cross-section observational study in the United States.
        Arch Bone Jt Surg. 2015; 3: 13-18
        • Konda S.R.
        • Davidovitch R.I.
        • Egol K.A.
        Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: An improvement over saline load test.
        J Orthop Trauma. 2013; 27: 498-504https://doi.org/10.1097/BOT.0b013e31828219bc
        • Konda S.R.
        • Howard D.
        • Davidovitch R.I.
        • Egol K.A.
        The saline load test of the knee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention.
        J Orthop Trauma. 2013; 27: 491-497https://doi.org/10.1097/BOT.0b013e31828211f3
        • Marvel J.E.
        • Marsh H.O.
        Management of penetrating injuries of the knee.
        Clin Orthop Relat Res. 1977; : 268-272
        • Metzger P.
        • Carney J.
        • Kuhn K.
        • Booher K.
        • Mazurek M.
        Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of the artificial traumatic knee arthrotomies.
        J Orthop Trauma. 2012; 26: 347-349https://doi.org/10.1097/BOT.0b013e3182255167
        • Nord R.M.
        • Quach T.
        • Walsh M.
        • Pereira D.
        • Tejwani N.C.
        Detection of traumatic arthrotomy of the knee using the saline solution load test.
        J Bone Joint Surg Am. 2009; 91: 66-70https://doi.org/10.2106/JBJS.G.01682
        • O’Driscoll S.
        • Morrey B.
        • Kai-Nan A.
        Intraarticular pressure and capacity of the elbow.
        Arthroscopy. 1990; 6: 100-1003
        • Olson S.A.
        • Willis M.D.
        Initial management of open fractures.
        in: Bucholz R.W. Heckman J.D. Court-Brown C.M. Rockwood and Green’s Fractures in Adults. 8th ed. Lippincott Williams & Wilkins, Philadelphia, PA2015: 382
        • Patzakis M.J.
        • Dorr L.D.
        • Ivler D.
        • Moore T.M.
        • Harvey Jr., J.P.
        The early management of open joint injuries: a prospective study of one hundred and forty patients.
        J Bone Joint Surg Am. 1975; 57: 1065-1070
        • Tornetta III, P.
        • Boces M.T.
        • Schepsis A.A.
        • Foster T.E.
        • Bhandari M.
        • Garcia E.
        How effective is a saline arthrogram for wound around the knee?.
        Clin Orthop Relat Res. 2008; 466: 432-435https://doi.org/10.1007/s11999-007-0006-5
        • Voit G.A.
        • Irvine G.
        • Beals R.K.
        Saline load test for penetration of periarticular lacerations.
        J Bone Joint Surg Br. 1996; 78: 732-733