Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study
Background: The objective of this study was to define the volume (mLs) needed for a positive saline load challenge test in anterolateral (AL), anteromedial (AM), posterolateral (PL), or posteromedial (PM) ankle arthrotomy wounds using normal saline (NS) and methylene blue (MB). Another objective was...
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doaj-09bf2217023b4f2c9ab54b679d22aa792020-11-25T03:46:04ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142020-03-01510.1177/2473011420905610Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric StudyPaul R. Allegra MD0Rafael A. Sanchez MD1Samuel Huntley MD, MPH2Loren Latta PhD3Sohil S. Desai BA4Jonathan Kaplan MD5Amiethab Aiyer MD6 University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, FL, USA University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, FL, USA University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, FL, USA Max Biedermann Institute for Biomechanics, FL, USA University of Miami Miller School of Medicine, Miami, FL, USA Hoag Orthopedic Institute, CA, USA University of Miami Miller School of Medicine, Department of Orthopaedic Surgery, Miami, FL, USABackground: The objective of this study was to define the volume (mLs) needed for a positive saline load challenge test in anterolateral (AL), anteromedial (AM), posterolateral (PL), or posteromedial (PM) ankle arthrotomy wounds using normal saline (NS) and methylene blue (MB). Another objective was to evaluate the use of fluoroscopy and iodinated contrast in the diagnosis of ankle arthrotomies. Methods: Four cadaveric ankle specimens underwent standardized arthrotomy creation in either the AL, AM, PL, or PM portion of each specimen. An 18-gauge needle was used to inject fluid into each ankle, and the volumes needed for positive fluid challenges were recorded. All 4 ankles were tested 10 times (n = 40) with NS and 10 times using MB (n = 40). A fifth cadaveric ankle was injected with radiopaque contrast solution, and an arthrotomy was simulated and imaged with fluoroscopy.Statistical analyses compared the volumes of NS and MB needed for a positive test. In addition, the 25th, 50th, 75th, 90th, and 95th percentiles of volumes needed for a positive test was calculated. Results: The volume of fluid necessary to detect 25%, 50%, 75%, 90%, and 95% of ankle arthrotomies from any site was 2.0 mL, 4.5 mL, 9.0 mL, 10 mL, and 10 mL, respectively. Anterior arthrotomies required less fluid (2.1 mL ± 0.5) than posterior arthrotomies (9.0 mL ± 1.2) for a positive test ( P < .0001). There was no difference between the amount of NS (5.5 mL ± 3.6) vs MB (5.6 mL ± 3.7) needed for a positive challenge test ( P = .739). Conclusion: Ninety-five percent of ankle arthrotomies could be diagnosed with 10 mL of injected fluid; there was no difference between the volume of NS vs MB needed. Fluoroscopy assisted with needle placement and can be combined with radiopaque contrast solution to diagnose ankle arthrotomies. Clinical Relevance: The findings of this study may improve sensitivity and efficiency in the diagnosis of traumatic ankle arthrotomies, for which there is currently a paucity of literature.https://doi.org/10.1177/2473011420905610 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul R. Allegra MD Rafael A. Sanchez MD Samuel Huntley MD, MPH Loren Latta PhD Sohil S. Desai BA Jonathan Kaplan MD Amiethab Aiyer MD |
spellingShingle |
Paul R. Allegra MD Rafael A. Sanchez MD Samuel Huntley MD, MPH Loren Latta PhD Sohil S. Desai BA Jonathan Kaplan MD Amiethab Aiyer MD Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study Foot & Ankle Orthopaedics |
author_facet |
Paul R. Allegra MD Rafael A. Sanchez MD Samuel Huntley MD, MPH Loren Latta PhD Sohil S. Desai BA Jonathan Kaplan MD Amiethab Aiyer MD |
author_sort |
Paul R. Allegra MD |
title |
Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study |
title_short |
Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study |
title_full |
Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study |
title_fullStr |
Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study |
title_full_unstemmed |
Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study |
title_sort |
diagnosis of traumatic ankle arthrotomies using saline load tests, methylene blue, and radiopaque tracer: a cadaveric study |
publisher |
SAGE Publishing |
series |
Foot & Ankle Orthopaedics |
issn |
2473-0114 |
publishDate |
2020-03-01 |
description |
Background: The objective of this study was to define the volume (mLs) needed for a positive saline load challenge test in anterolateral (AL), anteromedial (AM), posterolateral (PL), or posteromedial (PM) ankle arthrotomy wounds using normal saline (NS) and methylene blue (MB). Another objective was to evaluate the use of fluoroscopy and iodinated contrast in the diagnosis of ankle arthrotomies. Methods: Four cadaveric ankle specimens underwent standardized arthrotomy creation in either the AL, AM, PL, or PM portion of each specimen. An 18-gauge needle was used to inject fluid into each ankle, and the volumes needed for positive fluid challenges were recorded. All 4 ankles were tested 10 times (n = 40) with NS and 10 times using MB (n = 40). A fifth cadaveric ankle was injected with radiopaque contrast solution, and an arthrotomy was simulated and imaged with fluoroscopy.Statistical analyses compared the volumes of NS and MB needed for a positive test. In addition, the 25th, 50th, 75th, 90th, and 95th percentiles of volumes needed for a positive test was calculated. Results: The volume of fluid necessary to detect 25%, 50%, 75%, 90%, and 95% of ankle arthrotomies from any site was 2.0 mL, 4.5 mL, 9.0 mL, 10 mL, and 10 mL, respectively. Anterior arthrotomies required less fluid (2.1 mL ± 0.5) than posterior arthrotomies (9.0 mL ± 1.2) for a positive test ( P < .0001). There was no difference between the amount of NS (5.5 mL ± 3.6) vs MB (5.6 mL ± 3.7) needed for a positive challenge test ( P = .739). Conclusion: Ninety-five percent of ankle arthrotomies could be diagnosed with 10 mL of injected fluid; there was no difference between the volume of NS vs MB needed. Fluoroscopy assisted with needle placement and can be combined with radiopaque contrast solution to diagnose ankle arthrotomies. Clinical Relevance: The findings of this study may improve sensitivity and efficiency in the diagnosis of traumatic ankle arthrotomies, for which there is currently a paucity of literature. |
url |
https://doi.org/10.1177/2473011420905610 |
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