Journal of Isfahan Medical School

Journal of Isfahan Medical School

Determining the Degree of Agreement between Computed Tomography Scan and Saline Test to Detect Knee Space Invading in Penetrating Trauma

Document Type : Original Article (s)

Authors
Fatemeh Mohammadi 1
Reza Mosaddegh 1
Samira Vaziri 1
Elham Zahedi 2
1 Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Resident, Department of Emergency Medicine, School of Medicine AND Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
10.22122/jims.v36i490.10347
Abstract
Background: Penetrating traumas to joints if not detected and properly treated, will be damaged, and causes intra-articular contamination and septic arthritis. At present, saline test is used to detect penetrating wound into the joint. Considering that it is invasive and painful, and is prone to infectious complications especially in busy emergency wards, the purpose of this study was to determine the consensus of computed tomography (CT) scan with saline test to increase the detection rate of penetrating knee trauma cases.Methods: This cross-sectional diagnostic study was done in the year 2017 in an emergency hospitals of the Iran University of Medical Sciences, Tehran, Iran. 62 patients with knee trauma were selected using convenience sampling method, and were evaluated using saline test and CT scan.Findings: Saline test was positive in 19 cases of 62 patients. Kappa agreement rate was 54.5% between the results of saline test with CT scan reported by radiologist and 43.9% with CT scan reported by emergency medicine specialist.Conclusion: According to the results of the study, there was no acceptable agreement between the results of saline test and CT scan, and CT scan could not be a good alternative to saline testing. However, concurrent testing and CT scan can be helpful; as there were negative results of saline test in cases of septic arthritis, which had positive CT scan results.
Keywords
Computed X ray tomography
Knee
Trauma
Infection
Complications
  1. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007; 357(22): 2277-84.
  2. Ast MP, Nam D, Haas SB. Patient-specific instrumentation for total knee arthroplasty: A review. Orthop Clin North Am 2012; 43(5): e17-e22.
  3. Sharareh B, Schwarzkopf R. Review article: Patient-specific versus standard instrumentation for total knee arthroplasty. J Orthop Surg (Hong Kong) 2015; 23(1): 100-6.
  4. Bridges JF, Jones C. Patient-based health technology assessment: A vision of the future. Int J Technol Assess Health Care 2007; 23(1): 30-5.
  5. Kapoor B, Clement DJ, Kirkley A, Maffulli N. Current practice in the management of anterior cruciate ligament injuries in the United Kingdom. Br J Sports Med 2004; 38(5): 542-4.
  6. Lam MH, Fong DT, Yung PS, Ho EP, Chan WY, Chan KM. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches. Sports Med Arthrosc Rehabil Ther Technol 2009; 1(1): 20.
  7. Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 2005; 39(3): 127-31.
  8. Leffers D. Dislocations and soft tissue injuries of the knee. In: Browner B, Levine A, Jupiter J, Trafton P, Krettek C, editors. Skeletal Trauma. Philadelphia, PA: Saunders; 1992.
  9. Watanabe AT, Carter BC, Teitelbaum GP, Bradley WG, Jr. Common pitfalls in magnetic resonance imaging of the knee. J Bone Joint Surg Am 1989; 71(6): 857-62.
  10. 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(7): 442-3.
  11. Solouki S, Namazi H, Etemadi S. Evaluation of diagnostic value of saline load test in penetrating periarticular injuries. Shiraz E Med J 2008; 9(4): 170-4.
  12. Stirling P, Tahir M, Atkinson HD. The limitations of Gram-stain microscopy of synovial fluid in concomitant septic and crystal arthritis. Curr Rheumatol Rev 2017. [Epub ahead of print].
  13. World Health Organization. World report on road traffic injury prevention. Geneva, Switzerland: WHO; 2004.
  14. Voit GA, Irvine G, Beals RK. Saline load test for penetration of periarticular lacerations. J Bone Joint Surg Br 1996; 78(5): 732-3.
  15. 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.
  16. Konda SR, Howard D, Davidovitch RI, Egol KA. 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): 491-7.
  17. Marashi SM, Ghazanfari Nasrabad M, Kargar O. Comparison of results of MRI and arthroscopy in traumatic knee injuries. Sci J Forensic Med 2016; 22(2):147-53. [In Persian].
  18. 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(1): 66-70.
  19. Orloff MT. The efficacy of the saline load test in determining the presence of traumatic arthrotomy of the knee [MSc Thesis]. Forest Grove, OR: School of Physician Assistant Studies, Pacific University; 2015.
  20. Browning BB, Ventimiglia AV, Dixit A, Illical E, Urban WP, Jauregui JJ. Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature. Acta Orthop Traumatol Turc 2016; 50(6): 597-600.
Journal of Isfahan Medical School
Volume 36, Issue 490 - Serial Number 490
July and August 2018
Pages 872-876

  • Receive Date 25 June 2018
  • Accept Date 06 April 2022