Computed tomography provides effective detection of traumatic arthrotomy of the elbow

Jackowski, Jacob R.; Wellings, Elizabeth P.; Cancio-Bello, Alexandra M; Nieboer, Micah J.; Barlow, Jonathan D.; Hidden, Krystin A.; Yuan, Brandon J.

doi:10.1016/j.jse.2023.01.028

Cited by 2 publications

(7 citation statements)

References 14 publications

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“…In the knee study published by Konda et al, the mean size of the wounds evaluated in the emergency department was 3.6 cm versus wounds that were 1 cm or smaller in our study and the other cadaveric studies performed in the wrist, elbow, and shoulder. 5,8,9,12,13 Importantly, the clinical significance of a small uncontaminated TA missed by a CT scan is unknown. Historical studies document a 27% infection rate of untreated TA, which stems from combat injuries sustained in World War II.…”

Section: Discussionmentioning

confidence: 99%

“…CT scan was 0% sensitive for detecting a TA in their study versus 100% for the SLT. Conversely, Jackowski et al 8 made a laterally based elbow TA and found that a CT scan effectively detected all arthrotomies with 100% sensitivity. Less definitive findings have been demonstrated in cadaveric studies of the wrist and shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…The number of specimens included is consistent with previous studies comparing CT scans with the SLT in detecting traumatic arthrotomies in the wrist, elbow, and shoulder. 8,9,[11][12][13] Inclusion criteria were an intact ankle with no evidence of ankle trauma. Exclusion criteria were a history of previous ankle surgery or ankle trauma.…”

Section: Methodsmentioning

confidence: 99%

“…The ankle was taken through 10 cycles of a range of motion in dorsiflexion-plantarflexion and inversion-eversion, consistent with previous cadaveric studies in alternate joints. 8,9,11,12 After the range of motion cycling, the specimen underwent a repeat CT scan.…”

Section: Methodsmentioning

confidence: 99%

“…5 In addition, cadaveric studies comparing the ability of a CT scan to detect traumatic wrist and elbow arthrotomies versus SLT have shown a similar sensitivity between the 2 methods. 8,9 As a result, using a CT scan to diagnose TA has gained popularity and been incorporated into diagnostic and treatment algorithms. 1 Historical data suggest that the ankle is the second most common joint in the lower extremity to sustain a TA, behind the knee, with an overall frequency ranging from 1.5% to 10% of all open joint injuries.…”

Section: Introductionmentioning

confidence: 99%

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Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Kallevang,

Berault,

Olsen

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVE: Periarticular wounds present a common diagnostic dilemma for emergency providers and orthopedic surgeons, as traumatic arthrotomies (TA) often necessitate different management from superficial soft tissue wounds. Historically, TA have been diagnosed with the saline load test (SLT). Computed tomography (CT) scan has been studied as an alternative to SLT in diagnosing TA in several joints, but there is limited data specifically pertaining to the ankle. This study aimed to compare the ability of a CT scan to identify an ankle TA versus a traditional SLT. The hypothesis was there would be no significant difference between a CT scan and SLT in diagnosing ankle TA in a cadaveric model. METHODS: This cadaveric study utilized ten thawed fresh-frozen cadaveric ankles. A baseline CT scan was performed to ensure no intra-articular air existed before simulated TA. After the baseline CT, a 1 cm TA was created in the anterolateral arthroscopy portal site location. The ankles then underwent a post-arthrotomy CT scan to evaluate for the presence of intra-articular air. After the CT scan, a 30 mL SLT was performed using the anteromedial portal site location. RESULTS: Following arthrotomy, intra-articular air was visualized in seven of ten cadavers in the post-arthrotomy CT scan. All the ankles had fluid extravasation during the SLT with less than 10 mL of saline. The sensitivity of the SLT for TA was 100% versus 70% for the CT scan. CONCLUSION: The SLT was more sensitive in diagnosing 1 cm ankle TA than a CT scan in a cadaveric model.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Kallevang,

Berault,

Olsen

et al. 2024

Journal of Orthopaedic Trauma

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An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction

Cui,

Ji,

Zha

et al. 2024

Sensors

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Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

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Computed tomography provides effective detection of traumatic arthrotomy of the elbow

Cited by 2 publications

References 14 publications

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction

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