Open joint injury - Revision history

Rossdonaldson1: /* Evaluation */

2025-03-19T20:19:49Z

Evaluation

← Older revision		Revision as of 20:19, 19 March 2025
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	===Diagnosis===		===Diagnosis===
	====CT Scan====		====CT Scan====
			*First-line diagnostic test
	*~100% specific and sensitive for a clinically significant open joint injuries<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>		*~100% specific and sensitive for a clinically significant open joint injuries<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>
	*Currently first line diagnostic test

	====Saline Loading Test====		====Saline Loading Test====
	*~~Those~~ in which joint penetration is unclear ~~can have~~ joint ~~loaded with either~~ saline or methylene blue to look for extravasation from wound.		*Second-line diagnostic test
	**Sensitivity increases with increased fluid injected, but ~~may be too low at frequently used amounts~~.		**For those in which joint penetration is unclear
	**~~However, negative~~ joint loading test ~~was~~ associated with 0% infection rate in one study with non-operative management.<ref>Konda, S. R., Howard, D., Davidovitch, R. I. & Egol, K. A. The saline load test of theknee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J. Orthop. Trauma 27, 491–497 (2013).</ref>		**Involves injection into the joint (see [[arthrocentesis]] for procedural landmarks and technique) of saline or methylene blue to look for extravasation from wound.
			**Sensitivity increases with increased fluid injected, but so does pain.
			**Negative joint loading test associated with 0% infection rate in one study with non-operative management.<ref>Konda, S. R., Howard, D., Davidovitch, R. I. & Egol, K. A. The saline load test of theknee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J. Orthop. Trauma 27, 491–497 (2013).</ref>
	**For knees, 50 mL is standard (sensitivity 46%, increased with ROM).		**For knees, 50 mL is standard (sensitivity 46%, increased with ROM).
	***>195 mL loading (very painful) needed for 95% sensitivity in small lacerations near the knee.<ref>Keese, G. R., Boody, A. R., Wongworawat, M. D. & Jobe, C. M. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J. Orthop. Trauma 21, 442–443 (2007).</ref>		***>195 mL loading (very painful) needed for 95% sensitivity in small lacerations near the knee.<ref>Keese, G. R., Boody, A. R., Wongworawat, M. D. & Jobe, C. M. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J. Orthop. Trauma 21, 442–443 (2007).</ref>

Rossdonaldson1: /* Injection */

2025-03-19T20:16:54Z

Injection

← Older revision		Revision as of 20:16, 19 March 2025
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	*Currently first line diagnostic test		*Currently first line diagnostic test

	====~~Injection~~====		====Saline Loading Test====
	*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.		*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.
	**~~Debate on sensitivity and specificity – some say sensitivity is far~~ too low.		**Sensitivity increases with increased fluid injected, but may be too low at frequently used amounts.
	**However, negative joint loading test was associated with 0% infection rate in one study with non-operative management.<ref>Konda, S. R., Howard, D., Davidovitch, R. I. & Egol, K. A. The saline load test of theknee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J. Orthop. Trauma 27, 491–497 (2013).</ref>		**However, negative joint loading test was associated with 0% infection rate in one study with non-operative management.<ref>Konda, S. R., Howard, D., Davidovitch, R. I. & Egol, K. A. The saline load test of theknee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J. Orthop. Trauma 27, 491–497 (2013).</ref>
	**For knees, 50 mL is standard (sensitivity 46%, increased with ROM).		**For knees, 50 mL is standard (sensitivity 46%, increased with ROM).

Rossdonaldson1: /* CT Scan */

2025-03-19T20:15:21Z

CT Scan

← Older revision		Revision as of 20:15, 19 March 2025
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	===Diagnosis===		===Diagnosis===
	====CT Scan====		====CT Scan====
	*~~A 2013 study suggests air in joint on CT of periarticular joint fracture is~~ 100% specific and sensitive for a clinically significant open joint ~~compared to saline loading test- SLT(level III)~~<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>		*~100% specific and sensitive for a clinically significant open joint injuries<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>
	**Study performed on 63 knee joints		*Currently first line diagnostic test
	**Patients in the study were still discharged with Augmentin 875 BID if CT/SLT negative

	====Injection====		====Injection====

Rossdonaldson1: /* Evaluation */

2025-03-19T17:42:09Z

Evaluation

← Older revision		Revision as of 17:42, 19 March 2025
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	==Evaluation==		==Evaluation==
	[[File:Radiopedia knee.png\|thumb\|Knee CT showing pneumoarthrosis consistent with open joint injury.]]		[[File:Radiopedia knee.png\|thumb\|Knee CT showing pneumoarthrosis consistent with open joint injury.]]

	===Workup===		===Workup===
			''All lacerations should have basic exploration; for those near a joint, depending on ''
	*[[ATLS]]		*[[ATLS]]
	*X-ray		**Trauma labs PRN
	*CT ~~– look for air in joint~~		*Consider X-ray
	*Trauma labs PRN		*Consider CT

	===Diagnosis===		===Diagnosis===
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	====Injection====		====Injection====

	*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.		*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.
	**Debate on sensitivity and specificity – some say sensitivity is far too low.		**Debate on sensitivity and specificity – some say sensitivity is far too low.

Rossdonaldson1: /* =CT Scan */

2025-03-19T17:39:00Z

=CT Scan

← Older revision		Revision as of 17:39, 19 March 2025
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	===Diagnosis===		===Diagnosis===
	====CT Scan===		====CT Scan====
	*A 2013 study suggests air in joint on CT of periarticular joint fracture is 100% specific and sensitive for a clinically significant open joint compared to saline loading test- SLT(level III)<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>		*A 2013 study suggests air in joint on CT of periarticular joint fracture is 100% specific and sensitive for a clinically significant open joint compared to saline loading test- SLT(level III)<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>
	**Study performed on 63 knee joints		**Study performed on 63 knee joints

Rossdonaldson1: /* Differential Diagnosis */

2025-03-19T17:38:37Z

Differential Diagnosis

← Older revision		Revision as of 17:38, 19 March 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Extremity trauma DDX}}		{{Extremity trauma DDX}}

			===Intra-articular gas===
			*[[Open joint injury]]
			*Surgical intra-articular intervention
			*[[Septic arthritis]]
			*Normal variation (i.e., intra-articular vacuum phenomena)

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Diagnosis */

2025-03-19T17:36:44Z

Diagnosis

← Older revision		Revision as of 17:36, 19 March 2025
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	===Diagnosis===		===Diagnosis===
			====CT Scan===
			*A 2013 study suggests air in joint on CT of periarticular joint fracture is 100% specific and sensitive for a clinically significant open joint compared to saline loading test- SLT(level III)<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>
			**Study performed on 63 knee joints
			**Patients in the study were still discharged with Augmentin 875 BID if CT/SLT negative

			====Injection====

	*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.		*Those in which joint penetration is unclear can have joint loaded with either saline or methylene blue to look for extravasation from wound.
	**Debate on sensitivity and specificity – some say sensitivity is far too low.		**Debate on sensitivity and specificity – some say sensitivity is far too low.
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	**For elbows, 20 mL with range of motion gave 86% sensitivity, 40 mL gave 95%.<ref>Feathers, T. et al. Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies. J. Trauma 71, E110–113 (2011).</ref>		**For elbows, 20 mL with range of motion gave 86% sensitivity, 40 mL gave 95%.<ref>Feathers, T. et al. Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies. J. Trauma 71, E110–113 (2011).</ref>
	**For ankle, 10 mL is average needed, 23 mL and 30 mL for 90% and 95% sensitivity.<ref>Bariteau, J. T., Blankenhorn, B. D. & Digiovanni, C. W. Evaluation of saline load test for simulated traumatic arthrotomies of the ankle. Injury 44, 1498–1501 (2013).</ref>		**For ankle, 10 mL is average needed, 23 mL and 30 mL for 90% and 95% sensitivity.<ref>Bariteau, J. T., Blankenhorn, B. D. & Digiovanni, C. W. Evaluation of saline load test for simulated traumatic arthrotomies of the ankle. Injury 44, 1498–1501 (2013).</ref>
	*A 2013 study suggests air in joint on CT of periarticular joint fracture is 100% specific and sensitive for a clinically significant open joint compared to saline loading test- SLT(level III)<ref>Konda, S. R., Davidovitch, R. I. & Egol, K. A. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J. Orthop. Trauma 27, 498–504 (2013).</ref>
	**Study performed on 63 knee joints
	**Patients in the study were still discharged with Augmentin 875 BID if CT/SLT negative

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2025-03-19T17:34:55Z

Evaluation

← Older revision		Revision as of 17:34, 19 March 2025
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	==Evaluation==		==Evaluation==
			[[File:Radiopedia knee.png\|thumb\|Knee CT showing pneumoarthrosis consistent with open joint injury.]]
	===Workup===		===Workup===
	*[[ATLS]]		*[[ATLS]]

Rossdonaldson1: /* Background */

2025-03-19T16:11:42Z

Background

← Older revision		Revision as of 16:11, 19 March 2025
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	==Background==		==Background==
			[[File:Gray299.png\|thumb\|Generic diagram of a joint.]]
	*Also known as "traumatic arthrotomy"		*Also known as "traumatic arthrotomy"
	*Soft tissue injury that penetrates the joint space and exposes the joint space to the environment.		*Soft tissue injury that penetrates the joint space and exposes the joint space to the environment.

Rossdonaldson1: /* External Links */

2019-08-14T03:23:54Z

External Links

← Older revision		Revision as of 03:23, 14 August 2019
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	==External Links==		==External Links==
	[http://emedicine.medscape.com/article/114453-overview#a7 General overview of joint loading test with methylene blue]		*[http://emedicine.medscape.com/article/114453-overview#a7 General overview of joint loading test with methylene blue]

	==References==		==References==