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

Abstract

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

Battle Royale

“…These volumes were nearly half the amount recommended by Feathers et al 1 who found 40 mL necessary to obtain a 95% sensitivity. A case study of pediatric elbow traumatic arthrotomies confirmed that the previous studies held merit in their volume recommendations, indicating positive results between 20 and 30 mL 13 .…”

“…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. In arthroscopic test subjects, variability in joint volume thresholds of a particular joint can be dependent on capsular volumes and elasticity, synovial outpouching, underlying arthritic changes, plicae, and the patient's age 9,10,13,15,18 . Finally, arthrotomy wounds created for the various studies are not representative of what is seen in clinical practice, where periarticular wounds are of varying sizes 4,9,16,18,19 .…”