Does the Saline Load Test Still Have a Role in the Orthopaedic World? A systematic review of the literature.

Abstract

Introduction: Periarticular injuries are important to evaluate as joint penetration may result in septic arthritis. Although the gold-standard to evaluate the integrity of the joint capsule is surgical exploration, this requires extensive operative resources and is costly. Saline Load Tests (SLTs) have consequently been used in emergent settings to evaluate extension of periarticular wounds into capsule. Since no study has comprehensively evaluated the ability of SLT to detect open wound injuries within different joints, we systematically evaluated all literature.

Methods: We systematically evaluated the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle utilizing specific inclusion/exclusion criteria.  

Results: The SLT values to determine knee arthrotomies vary from 73.8 mL to 194 mL with sensitivities ranging from 91%-99% depending on the size of the laceration. A SLT of 30 mLs in the ankle yields sensitivities ranging from 95-99% in assessing joint penetration. A SLT of 45 mL in the elbow yields a sensitivity of 95% in assessing joint penetration. The addition of methylene blue does not change the sensitivity of the SLT.

Conclusion: Penetrating joint injuries require prompt diagnosis to avoid deleterious sequelae.  Several groups have demonstrated the utility of the SLT as a diagnostic modality for such injuries.  However, the literature analyzed in this study was inconclusive and more studies are required to make definitive recommendations. In addition, more studies will be needed on joints other than the knee, pediatric patients, and the use of methylene blue dye in conjunction with SLT.

 

DOI: 10.3944/AOTT.2016.15.0398
This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

Keywords

• Saline load test;knee arthrotomy, joint arthrotomy;traumatic joint injury.