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Effectiveness of the saline load test in diagnosis of simulated traumatic ankle arthrotomies

Injury Mar 03, 2020

Ohliger E, et al. - Researchers undertook this work exploring the amount of fluid required and the sensitivity of the saline load test for recognition of an intra-articular arthrotomy of the ankle. Assessment of volume required to detect ankle arthrotomies at varying arthrotomy locations was done using cadavers without prior ankle trauma or surgeries. It was hypothesized that the site of arthrotomy would determine the volume needed. Based on arthrotomy location, they performed a division of 20 thawed, fresh-frozen below-knee cadavers into four groups. Using a 4 mm trochar, they made an ankle arthrotomy at the four standard ankle portal sites; anteromedial, anterolateral, posteromedial, and posterolateral. An arthroscope was inserted for direct visualization of the ankle joint to confirm intra-articular location. Then, insertion of an 18-gauge needle was done into the ankle joint, and injection of saline mixed with methylene blue was administered. During the injection, they monitored the known arthrotomy site for extravasation. Record of the amount of saline required to diagnose arthrotomy was made. By demonstrating methylene blue staining of the anterior joint, they confirmed all injections as intra-articular. As per outcomes, an injection of 10 mL identified 95% of arthrotomies nearly 4 mm in size in the cadaver model. Volumes needed to detect arthrotomies may be overestimated in prior arthroscopic studies. They identified no difference in the volume required to detect arthrotomies across varying arthrotomy locations.
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