Detection of traumatic elbow arthrotomies: computed tomography scan vs. saline load test.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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.
Kupchick TD, Yousif MJ, Colen AJ, Fenkell BR, Faulkner AM. 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. PMID: 32444316.