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Detection of Traumatic Arthrotomy of the Wrist Using the Saline Load Test
William Slikker, MD; Rachel Frank; Christopher Bayne; Laith Al-Shihabi; John Fernandez; Robert Wysocki; Mark Cohen
Rush University, Chicago, IL

Introduction: Joint penetration of periarticular wrist injuries can be difficult to ascertain in the emergent setting. The saline load test is a minimally invasive procedure that can be easily performed in the triage setting. However, no studies have shown the amount of saline needed to produce an accurate and reliable result in vivo in the wrist. Therefore, the purposes of this study are to identify the minimum fluid volume necessary to obtain 95% sensitivity for joint penetration in vivo, and to correlate the fluid volume needed for positive diagnosis with demographic factors. We hypothesize that we will be able to determine a reliable saline load needed to accurately identify a traumatic arthrotomy to the wrist.
Methods: Thirty consecutive patients scheduled for elective outpatient wrist arthroscopy were prospectively enrolled from 2012-2013. Patients with previous ipsilateral wrist surgery were excluded. A standard 3-4 portal was established with an #11 blade knife for all patients under traction, but without joint insufflation. The arthroscope was then inserted and under direct visualization, an 18-gauge needle was inserted in the 6R portal. The arthroscope and trocar were then removed, traction released, and sterile saline steadily injected until there was effusion from the 3/4 arthrotomy site. Logarithmic regression was used to analyze the saline load test volumes and to determine the sensitivity for a positive result, and correlation statistics was used to compare the injected volumes to demographic data.
Results: In 30 consecutive patients that underwent the saline load test, it took an average volume of 0.74ml (SD = 0.69) to achieve a positive result and induce effusion through the 3/4 arthrotomy site. No correlation was observed between the gender, height, weight, or body mass index (BMI) of the patients and the amount of saline injected. A saline load of 0.5ml was injected to achieve 70% sensitivity; 1ml was injected to achieve 80% sensitivity, and 3ml was required to achieve 95% sensitivity for a positive saline load test.
Conclusion: This study demonstrates that only 1ml of saline needs to be injected for the saline load test to identify a majority of traumatic wrist arthrotomies. However, 3ml will need to be injected into the wrist to detect 95% of wrist arthrotomies. These values are applicable to a wide array of patients of both genders and with different height, weights, and BMIs, as there was no correlation between patient demographics and the amount injected to obtain a positive result.


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