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

Kupchick, Tyler D; Yousif, Matthew J.; Colen, Alexander; Fenkell, Blake R.; Faulkner, Alfred

doi:10.1016/j.jse.2020.02.012

Cited by 18 publications

(37 citation statements)

References 13 publications

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“…Each patient was then able to undergo minor surgical intervention of irrigation and debridement with a short course of prophylactic oral antibiotics to prevent a deep infection or septic joint. Per our literature review ( Table 1 ), most TEA detection literature references cadaveric studies [ 6 , 12 ] and only one human case report [ 3 ]. In general, the majority of traumatic arthrotomy literature pertains to the knee, which has demonstrated unparalleled results to the elbow and may cloud the judgment of TEA detection method.…”

Section: Discussionmentioning

confidence: 99%

“…Kupchick et al [ 12 ] is the only study to compare SLT with CT scan for TEA. Using 10 cadaveric specimens, they made a controlled arthrotomy and then brought the specimens through full range of motion.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, any laceration around the elbow needs to be evaluated for a traumatic arthrotomy. A diligent physical examination of the injured extremity is required yet may not be enough to identify disruption of the joint capsule, i.e., traumatic arthrotomy [ 2 , 6 , 7 , 8 , 12 , 14 ]. An open arthrotomy can seed bacteria from the skin or environment into the joint and develop into septic arthritis [ 1 , 5 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Elbow Arthrotomy Pediatric Case Report: The Saline Load Test is a Reliable Method of Detection

Kupchick¹,

Wall²

2021

JOCR

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Introduction: Lacerations and open elbow injuries are common emergency department visits which necessitate an orthopedic surgery evaluation for a traumatic elbow arthrotomy (TEA). A delay in this diagnosis can lead to septic arthritis, requiring more invasive surgical procedures, prolonged antibiotics, and possible long-term sequelae. To date, there is scarce literature on TEA. The purpose of this case report is to better educate the orthopedic community on a reliable method of detection for a TEA, including pediatric patients. Case Report: Case 1 – Twelve-year-old boy sustained a traumatic dog bite to the right elbow by a large stray dog. Evaluation in the emergency department revealed five 1 centimeter or smaller lacerations over the lateral elbow and another 1 cm laceration to the volar and proximal forearm. A saline load test (SLT) was performed from a posterior approach and was positive after 20cc of normal saline was injected into the joint. An arthroscopic irrigation and debridement were performed as definitive treatment. He was discharged with Augmentin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively revealed no signs of infection. Case 2 – Seven-year-old boy who was in a bicycle accident and sustained a large laceration over the posterior elbow. Evaluation in the emergency department revealed an approximately 15 by 4 cm laceration over the posterior elbow. A SLT was positive after 30cc’s was injected from the anterolateral approach. He underwent arthroscopic irrigation and debridement as definitive treatment and was discharged home with Cephalexin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively showed no signs of infection. Conclusion: Performing a SLT is a reliable method of detection to evaluate for a TEA. Our case report demonstrated confirmation of TEA in two pediatric patients based on positive SLT. We were able to treat these injuries appropriately with early surgical intervention and prophylactic anti

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Traumatic Elbow Arthrotomy Pediatric Case Report: The Saline Load Test is a Reliable Method of Detection

Kupchick¹,

Wall²

2021

JOCR

Self Cite

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“…In the setting of possible traumatic arthrotomy, the saline load test (SLT) is the most common and accepted diagnostic modality [6]. Therefore, in addition to being universally available, the SLT adds value compared to advanced imaging alternatives, which demonstrate lower sensitivities yet greater costs, thereby proving crucial [8]. SLT consists of an injection of a certain volume of sterile saline into a given joint separate from the site of injury, whereby extravasation of saline from the injury site is a positive result that indicates a capsular breach [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Published investigations have demonstrated poor accuracy of computerized tomography (CT) scans in diagnosing traumatic elbow arthrotomy. Kupchick et al [ 8 ] recently reported that zero out of ten iatrogenically arthrotomized cadaveric elbows demonstrated evidence of intra-articular air on CT, despite repetitive ranging of the joint. In the setting of possible traumatic arthrotomy, the saline load test (SLT) is the most common and accepted diagnostic modality [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation

Ferré¹,

Maurant²,

Steckler³

et al. 2021

Cureus

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BackgroundThe saline load test has not been well explored in the elbow. We aimed to determine 1) the saline infusion volume needed for 90%, 95%, and 99% sensitivity in detecting elbow arthrotomy; and 2) factors associated with higher volume at detection using sixteen forequarter upper extremity amputation cadavers. MethodsSixteen fresh-frozen forequarter upper extremity amputations were procured, and demographic data, including age, body mass index (BMI), and laterality, were recorded. The olecranon process, radial head, and the lateral epicondyle were palpated, and elbow arthrotomy was consistently performed at the direct lateral arthroscopic portal site. The elbow joint was loaded with saline mixed with methylene blue (concentration: 2 mg/300 mL) using an 18-gauge needle inserted just medial to the triceps tendon 2 cm superior to the olecranon. ResultsMean volume for extravasation was 12.2 mL ±6.26. Volume needed for 90%, 95%, and 99% sensitivities were 21 mL, 23 mL, and 25.4 mL. Linear regression demonstrated that increasing age was associated with lower volume to extravasation (OR: 0.67; 95% CI: 0.48-0.932; p=0.037), while BMI (p=0.571) and extremity laterality (p=0.747) did not affect the volume. ConclusionsThe saline load test can be effective in diagnosing the violation of the elbow joint in traumatic injuries. This test should be used in conjunction with the clinical examination and radiographs before operative decisions are made. We recommend using ≥26 mL to rule out traumatic elbow arthrotomy.

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Sterile Punktion großer Gelenke

Labmayr

Eckhart²,

Smolle

et al. 2023

Oper Orthop Traumatol

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Zusammenfassung Ziel Die Punktion großer Gelenke erfolgt einerseits zur Diagnostik und andererseits zur Behandlung von Gelenkspathologien. Mittels Punktion kann eine rasche Schmerzreduktion durch Entlastung von Ergüssen oder intraartikulären Hämatomen erfolgen. Das gewonnene Punktat erlaubt schon bei der Beschau mit dem freien Auge eine erste Einschätzung und in der Folge eine mikroskopisch-zytologische sowie mikrobiologische Befundung im Labor. Indikationen Die Punktion eines großen Gelenkes ist zur Diagnose und/oder Therapie bei entzündlichen, traumatischen oder postoperativen Gelenksveränderungen angezeigt. Diagnostische Punktionen dienen der Punktatgewinnung, der differentialdiagnostischen Schmerzausschaltung oder (selten) der Kontrastmittelapplikation für die Magnetresonanzarthrographie. Therapeutische Punktionen ermöglichen die Injektion von Medikamenten oder plättchenreichem Plasma (PRP) sowie die Entlastung bzw. Drainage von Ergüssen. Kontraindikationen Bei entzündlichen und insbesondere eitrigen Hautveränderungen im Punktionsbereich sind Gelenkpunktionen kontraindiziert. Obwohl keine absolute Kontraindikation, ist bei Einnahme blutgerinnungswirksamer Substanzen Vorsicht geboten. Operationstechnik Besonderes Augenmerk ist auf ein steriles Vorgehen zu legen. Unnötige Schmerzen können durch das sterile Setzen einer Lokalanästhesiequaddel, „sichere“ Punktionspunkte sowie vorsichtiges Hantieren mit den Punktionskanülen vermieden werden. Weiterbehandlung Punktate müssen entsprechend den lokalen, intrahospitalen Richtlinien zeitgerecht aufgearbeitet bzw. entsorgt werden. Die Punktionsstellen werden mit sterilem Pflasterverband abgedeckt, bei Medikamentenapplikation die Gelenke zur Verteilung des Wirkstoffes passiv durchbewegt. Danach erfolgt eine Kompressionsbehandlung mit elastischer Bandage von distal nach proximal bis über die Punktionsstelle zur Vermeidung von Nachblutungen oder sofortiger Ergussneubildung. Fakten Werden sämtliche Maßnahmen der Sterilität bei der Punktion großer Gelenke eingehalten, ist davon auszugehen, dass Infektionen mit 0,04–0,08 % (4 bis 8/10.000 Punktionen) nur sehr selten auftreten. Das Risiko für falsch positive Erregernachweise ist äußerst gering.

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

Cited by 18 publications

References 13 publications

Traumatic Elbow Arthrotomy Pediatric Case Report: The Saline Load Test is a Reliable Method of Detection

Traumatic Elbow Arthrotomy Pediatric Case Report: The Saline Load Test is a Reliable Method of Detection

The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation

Sterile Punktion großer Gelenke

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