Perloff Eric, Posner Andrew, Murtaza Hamza, Vig Khushdeep, Smith Michael, Mulligan Michael T
Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
Department of Anatomy, Anatomical Gift Program, Albany Medical College, Albany, New York.
J Wrist Surg. 2021 Oct 1;11(2):154-160. doi: 10.1055/s-0041-1735888. eCollection 2022 Apr.
Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.
腕关节创伤性切开术最常通过生理盐水负荷试验（SLT）来检测；然而，关于SLT对这个特定关节的有效性的数据很少。计算机断层扫描（CT）已被确认为检测膝关节创伤性切开术的替代方法，因为当关节囊受损时，可以看到关节内有气体。本研究的目的是确定CT扫描识别腕关节囊切开术的能力，并比较CT与传统SLT的诊断性能。本研究最初使用了10具经肱骨截肢的新鲜冷冻尸体。在干预前进行基线CT扫描，以确保关节内没有气体。基线CT扫描后，在6R桡腕入口处进行切开术。然后对腕关节进行切开术后CT扫描，以确定关节内是否有气体。CT扫描后，对腕关节进行SLT，以检测切开处是否有渗漏。基线CT扫描后纳入了9具尸体。切开术后，9具尸体中有8具在切开术后CT扫描中可见关节内有气体。9个腕关节中有8个在桡腕关节可见气体；9个腕关节中有7个在腕中关节可见气体；9个腕关节中有6个在桡尺远侧关节可见气体。所有腕关节（9个中的9个）在SLT期间均显示有渗漏。渗漏的平均体积为3.7毫升（标准差=2.6毫升），范围为1至7毫升。CT扫描正确识别了9个模拟创伤性切开术中的8个。在SLT期间注入7毫升才能100%识别所有切开术。在尸体模型中，CT扫描是检测腕关节创伤性切开术的一种敏感方法。
