Traumatic Arthrotomy

What It Is

• A deep traumatic laceration that extends through the joint capsule

Why It’s an Emergency

• A laceration into the joint exposes the normally sterile intra-articular contents to
external contamination, and can imminently become a septic arthritis.

How “Emergent” Is It?

• Urgent. Diagnosis must be made in a timely manner and should be taken to the
OR expeditiously, although not truly emergent if antibiotics have been started.

When to Be Suspicious

• Any penetrating trauma around a joint should be evaluated for potential trau-
matic arthrotomy.

© Springer International Publishing Switzerland 2017 23

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_7
24 J. Shillingford

Fig. 1 Positive saline load test

How to Diagnose

• Physical exam of wound and probing may be enough to confirm intra-articular

involvement. However, when unclear, the saline load test is considered the best diag-
nostic test (Appendix B: Saline load of knee technique). In this test, arthrocentesis of
the joint in question is performed, preferably with a portal away from the area of
injury, and with a large-bore needle (at least 18G) sterile saline is injected into the joint
while the laceration site is watched for saline extravasation. Sometimes over 150ccs is
required for larger joints with more distensible capsules (e.g., the knee) (Fig. 1).
• CT scan of knee can detect intra-articular air, indicating traumatic arthrotomy.

How to Treat

• Treatment is immediate IV antibiotics (typically a first-generation cephalospo-

rin) and urgent operative irrigation and debridement of the laceration and arthrot-
omy with joint irrigation, and possible synovectomy.

References

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.
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.