Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies

Feathers, Todd; Stinner, Daniel J.; Kirk, Kevin L.; Kirby, Jess M; Hsu, Joseph R.

doi:10.1097/ta.0b013e3182127840

Cited by 18 publications

(26 citation statements)

References 13 publications

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“…This finding is contradictory to reported results for the knee, elbow, and ankle, where saline load volume showed no such correlation. 2,3,5,6 However, Bariteau et al did find saline volumes required for extravasation in the ankle to be 14.5 mL in males and 7.3 mL in females with a p-value of 0.071. Crisco et al analyzed CT reconstructions to show that carpal bones are significantly larger in males.…”

Section: Discussionmentioning

confidence: 98%

“…Open wrist injuries have the potential to cause significant morbidity if not identified and treated urgently. 1 The saline load test for open arthrotomy, while well studied in various joints, [2][3][4][5][6] has not been studied in the wrist. In our study, we utilized wrist arthroscopy to simulate an arthrotomy and characterize the saline load test within the wrist.…”

Section: Discussionmentioning

confidence: 99%

“…as the suggested threshold, [2][3][4]6 while others suggested using the 99% sensitivity level as the threshold. 4,5 Computed tomography (CT) scan demonstrating intra-articular air has also shown to be a validated tool to diagnose traumatic knee arthrotomy, 7 though there is one report of CT not adequately diagnosing traumatic elbow arthrotomy.…”

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confidence: 99%

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Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist

et al. 2019

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Background Open injuries communicating with the wrist joint are essential to detect to facilitate timely, appropriate treatment. While the saline load test to detect traumatic arthrotomy has been well studied in the knee and ankle, it has not been studied in the wrist, and therefore the appropriate volume of saline infusion to detect traumatic arthrotomy is not known. Purpose The purpose of this study was to utilize wrist arthroscopy to determine the saline infusion volume necessary to achieve 99% sensitivity in detecting traumatic arthrotomy. Methods Twenty consecutive patients undergoing elective wrist arthroscopy were prospectively enrolled. A 5-mm arthrotomy was established between the third and fourth dorsal extensor compartments. An 18-gauge needle was inserted into the 6R portal on the radial side of the extensor carpi ulnaris. Sterile normal saline was injected into the wrist joint through the needle at a rate of 0.1 mL per second until extravasation from the 3–4 portal was visualized. Saline volumes required for extravasation were analyzed. Results The mean saline volume required for extravasation was 0.8 mL. The volume of saline needed to achieve sensitivities of 50, 90, 95, and 99% were 0.4, 2.2, 2.3, and 2.5 mL respectively. Conclusions The saline infusion volume required to detect a dorsal radiocarpal arthrotomy with 99% sensitivity was 2.5 mL. We recommend using at least 2.5 mL when performing the saline load test to rule out a potential arthrotomy to the wrist in the traumatic setting. Level of Evidence: This is a Level II, diagnostic study.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist

et al. 2019

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“…1 ). Six of these studies reported data from the SLT of the adult knee 4 , 5 , 7 , 8 , 10 , 11 one study reported data from SLT of the pediatric knee, 12 one study reported data from the wrist, 13 one study reported on data from cadaveric elbows, 14 and one study reported data from several different joints. 15 Additional cross-referencing of these studies yielded no further studies.…”

Section: Methodsmentioning

confidence: 99%

Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature

Browning¹,

Ventimiglia²,

Dixit³

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

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IntroductionThe aim of this systematic review was to assess the efficacy of Saline load tests (SLTs) to evaluate extension of periarticular wounds into capsule in emergent settings.MethodsWe systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle.ResultsThe SLT values to determine knee arthrotomies vary from 73.8 mL to 194 mL with sensitivities ranging between 91% and 99% depending on the size of the laceration. A SLT of 30 mL in the ankle yields sensitivities ranging from 95% to 99% in assessing joint penetration. A SLT of 45 mL in the elbow yields a sensitivity of 95% in assessing joint penetration. The addition of methylene blue does not change the sensitivity of the SLT.ConclusionSeveral studies have demonstrated the utility of the SLT as a diagnostic modality for penetrating joint injuries. However, the literature analyzed in this study was inconclusive and more studies are required to make definitive recommendations. In addition, more studies will be needed on joints other than the knee, pediatric patients, and the use of methylene blue dye in conjunction with SLT.Level of evidenceLevel II, Diagnostic study.

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“…Saline Solution Load Test to Identify Traumatic Arthrotomy of the Elbow ¤ A posterior arthrotomy was created in thirty-six cadaveric elbows, and a load test using 20 mL of saline solution was performed [11][12][13] . If the saline solution load test with range of motion was negative, the injection was continued until extravasation of fluid was achieved.…”

Section: Functional Elbow Motion Redefinedmentioning

confidence: 99%