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

Abstract

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. In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test. Descriptive cadaveric laboratory study. 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. Zero CT scans before (0/10) and after (0/10) the arthrotomieswere 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. 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.