Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist
06 September 2018
28 January 2019
08 March 2019 (eFirst)
Background Open injuries communicating with the wrist joint are essential to detect to facilitate timely, appropriate treatment. While the saline load test to detect traumatic arthrotomy has been well studied in the knee and ankle, it has not been studied in the wrist, and therefore the appropriate volume of saline infusion to detect traumatic arthrotomy is not known.
Purpose The purpose of this study was to utilize wrist arthroscopy to determine the saline infusion volume necessary to achieve 99% sensitivity in detecting traumatic arthrotomy.
Methods Twenty consecutive patients undergoing elective wrist arthroscopy were prospectively enrolled. A 5-mm arthrotomy was established between the third and fourth dorsal extensor compartments. An 18-gauge needle was inserted into the 6R portal on the radial side of the extensor carpi ulnaris. Sterile normal saline was injected into the wrist joint through the needle at a rate of 0.1 mL per second until extravasation from the 3–4 portal was visualized. Saline volumes required for extravasation were analyzed.
Results The mean saline volume required for extravasation was 0.8 mL. The volume of saline needed to achieve sensitivities of 50, 90, 95, and 99% were 0.4, 2.2, 2.3, and 2.5 mL respectively.
Conclusions The saline infusion volume required to detect a dorsal radiocarpal arthrotomy with 99% sensitivity was 2.5 mL. We recommend using at least 2.5 mL when performing the saline load test to rule out a potential arthrotomy to the wrist in the traumatic setting.
Level of Evidence: This is a Level II, diagnostic study.
This study was approved by our institutional IRB and the approval letter is attached.
- 1 Patzakis MJ, Dorr LD, Ivler D, Moore TM, Harvey Jr JP. The early management of open joint injuries. A prospective study of one hundred and forty patients. J Bone Joint Surg Am 1975; 57 (08) 1065-1070
- 2 Keese GR, Boody AR, Wongworawat MD, Jobe CM. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J Orthop Trauma 2007; 21 (07) 442-443
- 3 Nord RM, Quach T, Walsh M, Pereira D, Tejwani NC. Detection of traumatic arthrotomy of the knee using the saline solution load test. J Bone Joint Surg Am 2009; 91 (01) 66-70
- 4 Bariteau JT, Blankenhorn BD, Digiovanni CW. Evaluation of saline load test for simulated traumatic arthrotomies of the ankle. Injury 2013; 44 (11) 1498-1501
- 5 Bohl DD, Frank RM, Lee S. , et al. Sensitivity of the saline load test for traumatic arthrotomy of the ankle with ankle arthroscopy simulation. Foot Ankle Int 2018; 39 (06) 736-740
- 6 Feathers T, Stinner D, Kirk K, Kirby J, Hsu JR. ; Skeletal Trauma Research Consortium; Brooke Army Medical Center. Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies. J Trauma 2011; 71 (05) E110-E113
- 7 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 (09) 498-504
- 8 Bunyasaranand JC, Foeger NC, Ryan PM. Traumatic elbow arthrotomy after motorcycle accident not evident on CT. BMJ Case Rep 2017; 2017: xx
- 9 Voit GA, Irvine G, Beals RK. Saline load test for penetration of periarticular lacerations. J Bone Joint Surg Br 1996; 78 (05) 732-733
- 10 Crisco JJ, Coburn JC, Moore DC, Upal MA. Carpal bone size and scaling in men versus in women. J Hand Surg Am 2005; 30 (01) 35-42