Effectiveness of the saline load test in diagnosis of simulated traumatic ankle arthrotomies

Ohliger, Erin; Ohliger, James; Sultan, Assem A.; Miniaci-Coxhead, Sara Lyn

doi:10.1016/j.injury.2020.02.087

Cited by 9 publications

(13 citation statements)

References 10 publications

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“…The cadaver capsular tissue may also affect the air entry into the wrist joint. Prior studies have validated the assessment of traumatic arthrotomy using the SLT of the wrist, elbow, shoulder, and ankle in cadaveric models, 6 20 21 22 and cadavers have been used to evaluate CT of the knee and elbow. 8 23 In this setting, all arthrotomies were known and confirmed under fluoroscopic guidance prior to CT or SLT.…”

Section: Discussionmentioning

confidence: 99%

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

et al. 2021

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Background Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Materials and Methods Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Results Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. Conclusion CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. Clinical Relevance CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.

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Section: Discussionmentioning

confidence: 99%

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

et al. 2021

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“…While arthrotomy location variation is an acknowledged confounder, the association between specimen characteristics and saline load volume has not been previously described [ 3 , 13 , 14 ]. The present investigation was the first to highlight a significant association between greater age at specimen collection and diminished SLT required for extravasation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, overloading the joint with saline exposes patients to unnecessary discomfort due to increased intracapsular pressure and/or repetitive injection, in addition to the risk of intraarticular bacterial inoculation. SLT has been studied in the knee and ankle, with the recommended infusion volumes reported as 155 to 194 mL and 10 to 60 mL, respectively [9][10][11][12][13][14][15][16]. However, there is substantial controversy regarding the fluid volume required for elbow injection [3,4].…”

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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“…The evaluation of traumatic ankle arthrotomies has been limited to arthroscopic and cadaveric models with wide variances in volumes to correlate with higher sensitivities for TA. Bariteau et al 17 used an anterolateral arthroscopic arthrotomy approach and concluded that 30 mL was necessary to achieve 99% sensitivity. At the same time, Bohl et al 18 used 42 individuals having an elective arthroscopic procedure and concluded that a volume of 60 mL was needed to obtain a 99% sensitivity.…”

Section: Volume Thresholdsmentioning

confidence: 99%

Battle Royale

Desgrange

2023

JBJS Journal of Orthopaedics for Physician Assistants

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Effectiveness of the saline load test in diagnosis of simulated traumatic ankle arthrotomies

Cited by 9 publications

References 10 publications

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

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

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