Detection of traumatic elbow arthrotomies: computed tomography scan vs. saline load test

J Shoulder Elbow Surg. 2020 Sep;29(9):1869-1875. doi: 10.1016/j.jse.2020.02.012. Epub 2020 May 20.

Abstract

Background: Traumatic elbow arthrotomies are common injuries evaluated for by orthopedic services; however, failed identification of a traumatic arthrotomy leads to a high risk of developing septic arthritis. Currently these injuries are evaluated by either a saline load test or a computed tomography (CT) scan, yet there is little published evidence regarding detection of traumatic elbow arthrotomies.

Hypothesis: In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test.

Study design: Descriptive cadaveric laboratory study.

Methods: Ten fresh-frozen cadaveric transhumeral upper extremity amputation specimens were thawed for trial. Specimens were brought through CT scan prior to arthrotomy, arthrotomy was made, and then post arthrotomy a repeat CT scan was performed. A saline load test was then performed after all CT scans were completed.

Results: Zero CT scans before (0/10) and after (0/10) the arthrotomies were positive for intra-articular air in the elbow joint with a 0% sensitivity and specificity. The saline load test had an average positive test at 19 mL with a 100% sensitivity and 100% specificity.

Conclusion: After our study and based on the recommendations of the brief literature on this topic, we advise evaluating for traumatic elbow arthrotomies with a saline load test as the primary method of detection.

Keywords: Traumatic elbow arthrotomy; saline load test.

MeSH terms

  • Cadaver
  • Coloring Agents / administration & dosage
  • Elbow Joint / diagnostic imaging*
  • Elbow Joint / injuries*
  • Extravasation of Diagnostic and Therapeutic Materials*
  • Humans
  • Injections, Intra-Articular
  • Joint Capsule / diagnostic imaging*
  • Joint Capsule / injuries*
  • Methylene Blue / administration & dosage
  • Sensitivity and Specificity
  • Sodium Chloride / administration & dosage
  • Tomography, X-Ray Computed*

Substances

  • Coloring Agents
  • Sodium Chloride
  • Methylene Blue