Computed Tomography Scan to Detect Traumatic Arthrotomies and Identify Periarticular Wounds Not Requiring Surgical Intervention

Konda, Sanjit R.; Davidovitch, Roy I.; Egol, Kenneth A.

doi:10.1097/bot.0b013e31828219bc

Cited by 44 publications

(67 citation statements)

References 8 publications

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“…16 In another article, the authors have also reported that the CT scan has 100% sensitivity and is specific to detect traumatic arthrotomies and periarticular wounds not requiring surgical intervention. 17 Scolaro showed that CT scans found abnormal extra-luminal air to diagnose and manage open pelvic fractures. They revealed that only 36 of the 81 patients showed abnormal air on plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures

Suzuki

Nakayama

Matsui

et al. 2019

J Orthop Surg (Hong Kong)

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The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration. Methods: Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively. Results: Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually. Conclusions: In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.

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Section: Discussionmentioning

confidence: 99%

Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures

Suzuki

Nakayama

Matsui

et al. 2019

J Orthop Surg (Hong Kong)

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“…In the abdomen and pelvis, CT air densities can originate from multiple sources and should alert the treating physician to this possibility of an open pelvic ring injury, whenever identified. Identification of CT air densities about the knee has been described in the identification of open fractures and traumatic arthrotomies about the knee [6,7]. The use of abdominal and pelvic CT to evaluate the source of air densities, in an effort to increase identification of open pelvic ring injuries, has not been described.…”

Section: Introductionmentioning

confidence: 98%

Use of the initial trauma CT scan to aid in diagnosis of open pelvic fractures

Scolaro

Wilson

Routt

et al. 2015

Injury

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“…Historical studies from World War II reported infection rates up to 27% for traumatic knee arthrotomies managed non-operatively 1. Current standard of care for TA is operative irrigation and debridement (I&D) followed by antibiotics 2. Soft tissue injuries not penetrating the joint are managed with I&D either bedside or in the operating room depending on the severity.…”

Section: Introductionmentioning

confidence: 99%

“…These are CT scan,2 saline load tests (SLTs)3–6 and SLT with methylene blue 7. CT scan sensitivity and specificity for detecting TA with intra-articular air has been reported at 100% in other joints and has largely replaced the SLT 3.…”

Section: Introductionmentioning

confidence: 99%

Traumatic elbow arthrotomy after motorcycle accident not evident on CT

Bunyasaranand¹,

Foeger

Ryan

2017

BMJ Case Reports

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An 84-year-old man sustained a motorcycle accident resulting in a left elbow laceration. Orthopaedics was consulted to rule out traumatic arthrotomy. Radiographs and CT of the left elbow showed no acute osseous abnormalities and no evidence of traumatic arthrotomy. The wound was irrigated, dressed and splinted. On follow-up, the patient reported that he had been given clindamycin on a return visit to the emergency department for increased drainage. On inspection, the patient's wound was found sutured and draining purulent fluid. The patient persistently had no pain on axial loading or range of motion since his injury and no evidence of intra-articular air on initial CT. However, given the mechanism of injury, irrigation and debridement (I&D) in the operating room was immediately performed revealing purulent joint fluid and a traumatic arthrotomy. I&D was carried out for the second time in the joint. After an extended hospital stay and antibiotics, the infection resolved.

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Computed Tomography Scan to Detect Traumatic Arthrotomies and Identify Periarticular Wounds Not Requiring Surgical Intervention

Abstract: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 44 publications

References 8 publications

Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures

Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures

Use of the initial trauma CT scan to aid in diagnosis of open pelvic fractures

Traumatic elbow arthrotomy after motorcycle accident not evident on CT

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