Computed Tomography Scan to Detect Traumatic Arthrotomies and Identify Periarticular Wounds Not Requiring Surgical Intervention: An Improvement Over the Saline Load Test

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Abstract

Objective:

To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air.

Design:

Retrospective review.

Setting:

Level I trauma center.

Patients:

Sixty-two consecutive patients (63 knees) underwent a CT scan of the knee in the emergency department and had a minimum of 14 days follow-up. Cohort of 37 patients (37 knees) from the original 62 patients who underwent a saline load test (SLT).

Intervention:

CT scan and SLT.

Main Outcome Measurements:

Positive traumatic arthrotomy of the knee (+TAK) was defined as operating room (OR) confirmation of an arthrotomy or no intra-articular air on CT scan (−iaCT) (and −SLT if performed) with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy (pw = (−TAK)) was defined as OR evaluation revealing no arthrotomy or −iaCT (and −SLT if performed) with follow-up revealing no septic knee.

Results:

All 32 knees with intra-articular air on CT scan (+iaCT) had OR confirmation of a TAK and none of these patients had a knee infection at a mean follow-up of 140.0 ± 279.6 days. None of the 31 patients with −iaCT had a knee infection at a mean follow-up of 291.0 ± 548.1 days. Based on these results, the sensitivity and specificity of the CT scan to detect +TAK and pw = (−TAK) was 100%. In a subgroup of 37 patients that received both a CT scan and the conventional SLT, the sensitivity and specificity of the CT scan was 100% compared with 92% for the SLT (P < 0.001).

Conclusion:

CT scan performs better than the conventional SLT to detect traumatic knee arthrotomies and identify periarticular knee wounds that do not require surgical intervention and should be considered a valid diagnostic test in the appropriate clinical setting.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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