ID
Traumatic Arthrotomy
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Traumatic Arthrotomy
, Laceration with Joint Injury, Laceration Exposing Joint
See Also
Laceration
Septic Joint
Periprosthetic Joint Infection
Definitions
Traumatic Arthrotomy
Laceration
extends into joint capsule, exposing intra-articular surface with risk of
Septic Joint
Exam
Evaluate skin overlying joint
Laceration
s
Exposed bone or hardware
Erythema
Purulence
Joint Exam
Joint effusion
Joint range of motion (active and passive)
Observe
Laceration
s and wounds while performing joint range of motion
Observe for bubbles or viscous fluid exiting the wound during range of motion
Evaluate for concurrent injury
Open
Fracture
Open Dislocation
Other exam
Neurovascular Exam
Extremity compartments
Labs
Complete Blood Count
with differential
Inflammatory markers (CRP and ESR)
Diagnostics
Saline Load Test
Perform
Arthrocentesis
and instill saline into joint
Observe for saline leaking from
Laceration
(confirms Traumatic Arthrotomy)
Amount of saline to instill into joint varies by joint
Instilling 194 ml into knee offers
Test Sensitivity
of 95%
Keese (2007) J Orthop Trauma 21(7):442-3 +PMID: 17762473 [PubMed]
Imaging
XRay Joint
Air within joint has high
Test Specificity
, but low
Test Sensitivity
CT Joint
Offers better
Test Sensitivity
than XRay
However, has not been compared with Saline Load Test for all joints
Knee
CT for intraarticular air with 100%
Test Sensitivity
Saline load test by comparison has a
Test Sensitivity
of 92%
Konda (2013) J Orthop Trauma 27(9):498-504 +PMID: 23287770 [PubMed]
However
False Positive
air also occurs with closed intraarticular tibial
Fracture
s (knee)
Noble (2017) J Orthop Trauma 31(11): e381-4 [PubMed]
Precautions
No test completely excludes Traumatic Arthrotomy
Management
Emergently consult orthopedics
Operative joint wash-out is indicated in confirmed or suspected Traumatic Arthrotomy
Acute emergency department management
Reduce open
Fracture
s and open dislocations
Copious
Wound Irrigation
Update Tetanus
Vaccination
Joint Immobilization
Antibiotic
prophylaxis
Base
Staphylococcus
and
Streptococcus
coverage
First Generation Cephalosporin
(
Cefazolin
) OR
Vancomycin
if
MRSA
coverage indicated by patient history
Extensive
Soft Tissue Injury
Add
Gram Negative
coverage (e.g.
Third Generation Cephalosporin
,
Aminoglycoside
)
Wound
contaminated with organic matter
Add extended-spectrum
Penicillin
(e.g.
Piperacillin
-tazobactam)
Seawater contamination (
Vibrio vulnificus
risk)
Add
Doxycycline
Resources
Traumatic Arthrotomy (Emergency Physician Monthly)
https://epmonthly.com/article/confidently-rule-traumatic-arthrotomy-knee/
Traumatic Arthrotomy (Core EM)
https://coreem.net/core/traumatic-arthrotomy/
References
Augusta and Riveros (2024) Crit Dec Emerg Med 38(9): 20-1
Raukar and Swaminathan in Herbert (2021) EM: Rap 21(7): 4-5
Brubacher (2020) J Am Acad Orthop Surg 28(3):102-11 +PMID: 31977606 [PubMed]
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