Detection of traumatic elbow arthrotomies: computed tomography scan vs. saline load test.

BACKGROUND: Traumatic elbow arthrotomies are common injuries evaluated for by orthopedic services; however, failed identification of a traumatic arthrotomy leads to a high risk of developing septic arthritis. Currently these injuries are evaluated by either a saline load test or a computed tomography (CT) scan, yet there is little published evidence regarding detection of traumatic elbow arthrotomies. HYPOTHESIS: In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test. STUDY DESIGN: Descriptive cadaveric laboratory study. METHODS: Ten fresh-frozen cadaveric transhumeral upper extremity amputation specimens were thawed for trial. Specimens were brought through CT scan prior to arthrotomy, arthrotomy was made, and then post arthrotomy a repeat CT scan was performed. A saline load test was then performed after all CT scans were completed. RESULTS: Zero CT scans before (0/10) and after (0/10) the arthrotomies were positive for intra-articular air in the elbow joint with a 0% sensitivity and specificity. The saline load test had an average positive test at 19 mL with a 100% sensitivity and 100% specificity. CONCLUSION: After our study and based on the recommendations of the brief literature on this topic, we advise evaluating for traumatic elbow arthrotomies with a saline load test as the primary method of detection.

Distal Femoral Replacement Following an Intraoperative Periprosthetic Fracture in a Patient with Prior Bone Mulch ACL Reconstruction.

Periprosthetic distal femur fractures can be treated nonoperatively, with open reduction and internal fixation or with more constrained prostheses. Distal femoral replacement is typically a last resort treatment option for comminuted periprosthetic or osteoporotic distal femoral fractures in patients with poor bone stock or resistant nonunions. We report the case of a 54-year-old female with a remote history of bone mulch ACL reconstruction who sustained an intraoperative comminuted bicondylar distal femur fracture during a primary total knee arthroplasty. This patient was treated with a distal femoral replacement and successfully returned to her preoperative function.

C2 Solitary Bone Plasmacytoma Curettage and Vertebral Augmentation in an 83-Year-Old Female: Case Report and Review of Surgical Treatment Approaches in the Spine.

Surgically, solitary bone plasmacytoma (SBP) of the craniocervical junction (CCJ) is typically treated with cement augmentation and occipital-cervical stabilization (OCS). In the orthopedic spine literature, various surgical treatment options have been described for SBP, but only a few studies exist describing SBP of the CCJ with treatment involving cement augmentation alone. We report the case of an 83-year-old female found to have C2 SBP that was successfully treated with curettage and cement augmentation alone.