High risk and low prevalence diseases: Traumatic arthrotomy

Introduction: Traumatic arthrotomy (TA) is a rare but serious condition associated with a high morbidity and mortality that can be mitigated with prompt diagnosis and appropriate management. Objective: This review highlights the pearls and pitfalls of the emergency department (ED) evaluation of TA, including diagnostic procedures, imaging, and management based on current evidence. Discussion: Traumatic arthrotomy occurs when the joint capsule is disrupted during a penetrating injury. This exposes the intra-articular contents to contamination and poses a serious risk for development of septic arthritis. All periarticular injuries should prompt evaluation for TA, as missing this diagnosis can lead to significant morbidity and possibly mortality. ED evaluation options include plain radiographs, computerized tomography, and the saline load test. Each of these diagnostic modalities has unique limitations, and as such it is difficult to determine optimal practice or a standard of care. This is further complicated by the limited number of studies evaluating joints other than the knee. ED management includes orthopedic surgery consultation, wound care including irrigation, tetanus prophylaxis, and antibiotic administration. Conclusions: An understanding of an evidenced-based approach to TA can assist emergency clinicians in diagnosing and managing this challenging clinical presentation.