Background:Laceration around the joints may penetrate the synovial membrane barrier and contaminate the joint. Determining the penetration of the synovial membrane is important to the diagnosis. Saline load test has been used in the past to diagnosis penetrating joint injuries but the efficacy and safety of the test have not been determined. This study was designed to evaluate accuracy and safety of this procedure in penetrating periarticular injuries.
Materials and Methods:Between April 2002 till March 2003, 100 cases of Periarticular injuries to large joints with possibility of intra articular extension were studied. Clinical examination performed to determine the possibility of penetrating into the points. Then saline load test was performed by injecting appropriate qualities of saline into the joint, depending into the size of joint, watching for extravasations of saline with joint at rest and passive motion. Two weeks later patients examined in out patient clinic for evidence of any complications related to the test .
Result:the ratio of male to female was 19:1; the mean age at the time of injury was 27.4. Eighty two percent of injuries were due to road traffic accident, the knee was involved in 68% of cases. In 47 patients saline load test was positive. In 38% of them the result of clinical examination had predicted that the joint space might not be open to exterior. In 28% of 53 patients in whom saline load test was negative clinical prediction had indicated an open joint injury. Overall, the result of saline load test had changed the treatment planned on the basis of clinical prediction in 33% of patients. There was no complication related to the procedure.
Conclusion:decision making to operate or not the basis of clinical examination is risky and can have dangerous consequences. Saline load test is a safe and reliable method for diagnosis of intraarticular penetration of penetrating lacerations.
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