Saline Load Test: Is the joint involved?

20 Aug

saline1After you have gotten x-rays and have determined there is no fracture and no foreign body, can you close the above wound? First, you need to make sure there is no joint involvement that will require wash-out in the OR.

 

You can do a saline load test to find out.

Procedure:

  1. Prep and drape knee using sterile technique with knee relaxed and slightly flexed
  2. Inject local anesthetic or use Cetacaine over the site immediately prior to prep
  3. Insert needle (20 or 22 G) into joint– same location for knee injections- superior lateral approach works wellConfirm location by aspirating a small amount of joint fluid
  4. Insert 20+ cc sterile colored solution (methylene blue or fluorescein) or simply use sterile saline (will need larger volume ~60+cc as a small leak may not be as obvious without color change) into joint. 
  5. Inspect laceration for extravasation of fluid at rest and with passive movement.  Remember, the fluid extravasation can be subtle.
  6. If positive, start antibiotics and consult orthopedics for wash-out.

 

Note: the same can be done for elbow lacerations.  A lateral approach may be performed by going in through the triangle made by the radial head, olecranon, and lateral humeral epicondyle while aiming the needle toward the medial epicondyle.  See below:

saline2 

 

Common Pitfalls:

1.       Slow leakage of fluid/dye if the defect is small

2.       Mistaking fluid leakage for bleeding (easy to do- may need to inject more saline or try to identify where you think the bleeding is coming from)

3.       Insufficient amount of fluid injected

Note: It is unclear what the sensitivity of a saline load test is.  There are a few papers I have found with widely varying results.  

 

Submitted by H. Groth.

 

Sources-Wheeless’ Textbook of Orthopedics; EP Monthly article-Up-To-Date

 

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One Response to “Saline Load Test: Is the joint involved?”

  1. valeriedezarae October 8, 2013 at 19:36 #

    thanks!!!

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