REBEL Core Cast 131.0 – Traumatic Arthrotomy

Traumatic arthrotomy occurs when a deep laceration violates a joint capsule, exposing a sterile environment to external contaminants and risking septic arthritis or bacteremia. Clinical suspicion must remain high for any periarticular wound, regardless of size, necessitating thorough local wound exploration and probing. While the saline load test was historically the gold standard, its sensitivity is highly volume-dependent—requiring up to 200 mL in the knee for 95% accuracy—making it poorly tolerated by patients. Consequently, CT scans have become the diagnostic standard due to near 100% sensitivity in detecting intra-articular air. Management focuses on early orthopedic consultation, joint immobilization, and prophylactic antibiotics targeting staph and strep species, such as first-generation cephalosporins or vancomycin for MRSA. Definitive treatment typically involves surgical washout and exploration within 24 hours to prevent long-term morbidity.