The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation

Abstract

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.

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

“…The ankle was taken through 10 cycles of a range of motion in dorsiflexion-plantarflexion and inversion-eversion, consistent with previous cadaveric studies in alternate joints. 8,9,11,12 After the range of motion cycling, the specimen underwent a repeat CT scan.…”

Battle Royale

“…Elbow. TA of the elbow is the second most injured site, and the literature has been primarily based on cadaveric studies for evaluation 1,12 . Ferre et al 12 studied the volume thresholds in cadaveric elbows and found that to achieve 99% or higher sensitivity for TA, greater than 26 mL be introduced into the joint.…”

“…TA of the elbow is the second most injured site, and the literature has been primarily based on cadaveric studies for evaluation 1,12 . Ferre et al 12 studied the volume thresholds in cadaveric elbows and found that to achieve 99% or higher sensitivity for TA, greater than 26 mL be introduced into the joint. Earlier studies by Kupchick et al 4 concluded that to achieve 60% sensitivity, 15 mL was needed, and at 95% sensitivity, a total of 19 mL was recommended.…”

“…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.…”