Traumatic elbow arthrotomy after motorcycle accident not evident on CT

Bunyasaranand, John C; Foeger, Nicholas C.; Ryan, Paul M.

doi:10.1136/bcr-2017-221094

Cited by 8 publications

(11 citation statements)

References 11 publications

(4 reference statements)

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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%

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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%

“…The only case report on TEAs thus far was published by Bunyasaranand et al [ 3 ]. Their patient sustained a 6 cm elbow laceration from a motorcycle accident.…”

Section: Discussionmentioning

confidence: 99%

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

Kupchick¹,

Wall²

2021

JOCR

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“…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]. While some reports describe a 100% sensitivity at 20ml, others demonstrated that 95% sensitivity was only attained at 40ml of injected volume [3,8].…”

Section: Introductionmentioning

confidence: 99%

“…The presence of concurrent elbow arthrotomy may necessitate urgent irrigation with/without necrotic tissue debridement to avoid the development of septic arthritis, a devastating complication with associated irreversible joint destruction in as little as three days [ 4 , 5 ]. Notably, such aggressive interventions would not be warranted in the absence of joint arthrotomy.…”

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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“…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. 8 Despite the well-documented use of the saline load test in the knee, ankle, and elbow, there is insufficient characterization of the test for diagnosing traumatic wrist arthrotomy. Voit et al performed the saline load test on 50 consecutive patients with periarticular lacerations, two of which involved the wrist joint.…”

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confidence: 99%

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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Traumatic elbow arthrotomy after motorcycle accident not evident on CT

Cited by 8 publications

References 11 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

Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist

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