High risk and low prevalence diseases: Traumatic arthrotomy

Battle Royale

“…Needle placement is a vital component of a successful SLT. In settings outside of the ED, needle placement may be difficult because of patient discomfort with the potential for increased false-negative results 2,5,10 . A consideration in penetrating injuries is the proximity to the joint and the effectiveness of the SLT to elicit extravasation of fluid from the wound.…”

“…The standard treatment of this condition has historically been operative irrigation and debridement with antibiotic administration. It is known that TA itself is a risk factor for septic arthritis with a reported mortality rate of up to 15% and an increased risk of joint stiffness and limited mobility between 25% and 50% 5 . McKnight et al 6 argued that small traumatic arthrotomies absent of fracture had a low prevalence of complications when treated with bedside irrigation, wound closure, and antibiotics.…”

“…Volume Range Wrist 2.3-7 mL 1,5,14,15 Elbow 19-45 mL 1,4,5,8,12 Shoulder 81-136 mL 5,11 Hip N/A Knee 155-194 mL 1,5,8 Ankle 10-60 mL 1,5,10,17,19 a Recommended saline injection volume ranges based on the amount necessary to achieve at least 95% sensitivity for a positive traumatic arthrotomy.…”

“…Dynamic testing is where the joint, after the injection of saline, is brought through a range of motion and has been believed to potentially increase the sensitivity for TA compared with the more traditional static SLT 4,5,8,9,12 . Most of the studies used for determining volume thresholds were performed on cadaveric models and may not correlate with living tissue because of less elasticity and the potential for capsular rupture at lower pressure volumes.…”

“…The evaluation of TA with ultrasound is limited to a cadaveric study where 1 mL of air was introduced into the knee joint. The researchers found a sensitivity of 65% and a specificity of 75% but noted the limitations of no standard baseline for the amount of air seen in TA and limitations of physiology with a cadaveric model compared with a patient 5,21 . As time goes forward, more studies will need to assess the utility of ultrasound, given the increasing availability and safety associated with its use.…”