![PHOTOS: Jonathan Strong](https://www.acepnow.com/wp-content/uploads/2020/04/ACEP_0420_pg14a.png)
Dr. Strong is a clinical fellow in the department of emergency medicine at Brigham and Women’s Hospital in Boston.
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ACEP Now: Vol 39 – No 04 – April 2020References
- Patzakis MJ, Dorr LD, Ivler D, et al. The early management of open joint injuries. A prospective study of one hundred and forty patients. J Bone Joint Surg Am. 1975;57(8):1065-1070.
- Metzger P, Carney J, Kuhn K, Booher K, Mazurek M. Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies. J Orthop Trauma. 2012;26(6):347-9.
- Roberts JR, Custalow CB, Hedges JR, et al. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 6th ed. Philadelphia, PA: Elsevier; 2013.1092:4.
- Voit GA, Irvine G, Beals RK. Saline load test for penetration of periarticular lacerations. J Bone Joint Surg Br. 1996;78(5):732-733.
- Keese GR, Boody AR, Wongworawat MD, et al. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J Orthop Trauma. 2007;21(7):442-443.
- Tornetta P, Boes MT, Schepsis AA, et al. How effective is a saline arthrogram for wounds around the knee? Clin Orthop Relat Res. 2008;466(2):432-435.
- Nord RM, Quach T, Walsh M, et al. Detection of traumatic arthrotomy of the knee using the saline solution load test. J Bone Joint Surg Am. 2009;91(1):66-70.
- Haller JM, Beckmann JT, Kapron AL, et al. Detection of a traumatic arthrotomy in the pediatric knee using the saline solution load test. J Bone Joint Surg Am. 2015;97(10):846-849.
- Konda SR, Howard D, Davidovitch RI, et al. The saline load test of the knee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J Orthop Trauma. 2013;27(9):491-497.
- Konda SR, Davidovitch RI, Egol KA. 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. 2013;27(9):498-504.
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One Response to “Saline Load or CT: What’s the Best Test for Traumatic Arthrotomy?”
April 26, 2020
Joel Pasternack, MD, PhD, FACEPGood Article by Dr. Strong.
Clinical judgement can be enhanced as follows: Explore and irrigate wound through full range of motion. Obtain cross table lateral x-ray looking for air under the patella or in supra patella recess, after irrigation. The irrigation process will make the x-ray more sensitive for air without decreasing specificity. Gentle syringe irrigation will force more air into joint than may have entered from original injury.