Incidence of Vacuum Phenomenon Related Intra-articular or Subfascial Gas Found on Computer-Assisted Tomography (CT) Scans of Closed Lower Extremity Fractures

Noble, Tyler J.; Romeo, Nicholas M.; Lebrun, Christopher; DiPasquale, Thomas

doi:10.1097/bot.0000000000000962

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…For example, in the traumatic setting, a closed fracture creates a negative pressure gradient that pulls dissolved gas out of the tissue, leading to gaseous accumulation in closed intra-articular fractures. 24 Noble et al 24 found that this “vacuum phenomenon” accounted for the presence of intra-articular gas seen on CT in 20% of closed intra-articular fractures in their series.…”

Section: Discussionmentioning

confidence: 96%

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Kallevang,

Berault,

Olsen

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVE: Periarticular wounds present a common diagnostic dilemma for emergency providers and orthopedic surgeons, as traumatic arthrotomies (TA) often necessitate different management from superficial soft tissue wounds. Historically, TA have been diagnosed with the saline load test (SLT). Computed tomography (CT) scan has been studied as an alternative to SLT in diagnosing TA in several joints, but there is limited data specifically pertaining to the ankle. This study aimed to compare the ability of a CT scan to identify an ankle TA versus a traditional SLT. The hypothesis was there would be no significant difference between a CT scan and SLT in diagnosing ankle TA in a cadaveric model. METHODS: This cadaveric study utilized ten thawed fresh-frozen cadaveric ankles. A baseline CT scan was performed to ensure no intra-articular air existed before simulated TA. After the baseline CT, a 1 cm TA was created in the anterolateral arthroscopy portal site location. The ankles then underwent a post-arthrotomy CT scan to evaluate for the presence of intra-articular air. After the CT scan, a 30 mL SLT was performed using the anteromedial portal site location. RESULTS: Following arthrotomy, intra-articular air was visualized in seven of ten cadavers in the post-arthrotomy CT scan. All the ankles had fluid extravasation during the SLT with less than 10 mL of saline. The sensitivity of the SLT for TA was 100% versus 70% for the CT scan. CONCLUSION: The SLT was more sensitive in diagnosing 1 cm ankle TA than a CT scan in a cadaveric model.

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Section: Discussionmentioning

confidence: 96%

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Kallevang,

Berault,

Olsen

et al. 2024

Journal of Orthopaedic Trauma

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“…14 This phenomenon has also been described in the setting of closed lower extremity fractures. 15 We attempted to negate this as a potential confounder in our study by obtaining CT scans prior to creation of each arthrotomy. One must be careful to assume the vacuum phenomenon is a false positive in the setting of a periarticular wound.…”

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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“…Recently, Noble et al reported that they found gas in as many as 23.5% (27 of 88) of closed tibial fractures using CT scans. 4 The authors speculated that the acute joint dislocation or a closed fracture produces negative pressure where dissolved gas from the solution results in gas accumulation, which is known as the vacuum phenomenon. In the present study, 3 of the 45 closed shaft fractures showed air in the leg.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been reported that the presence of air in the leg was not rare on a computed tomography (CT) scan, even in closed lower extremity fractures. 4 Thus, there remains controversy whether air in the leg is representative of contamination.…”

Section: Introductionmentioning

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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Incidence of Vacuum Phenomenon Related Intra-articular or Subfascial Gas Found on Computer-Assisted Tomography (CT) Scans of Closed Lower Extremity Fractures

Abstract: Level IV.

Cited by 12 publications

References 18 publications

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan vs. Saline Load Test

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

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

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