Lit Matters 3: Traumatic arthrotomy - Do they need the OR?

Traumatic arthrotomy does not automatically require the operating room. For small periarticular wounds with minimal contamination, septic arthritis appears uncommon with bedside irrigation, closure, antibiotics, and close orthopedic follow-up, while heavily contaminated injuries and associated fractures remain a different category.

Traumatic Arthrotomy Management

• Selective nonoperative pathway: Small wounds under 5 cm with minimal to no contamination were the group most often managed without the OR, challenging the old dogma that every violated joint needs formal operative washout.
• Septic arthritis signal: In this multicenter cohort, septic arthritis was rare overall, with 1 case in the nonoperative group versus 7 in the operative group, though the surgical patients started with more severe injuries.
• Markers of higher risk: Large wounds, heavy contamination, intraarticular fracture, and other associated injuries were the common reasons patients went to the OR, a distinction worth hearing in the episode.
• Diagnosis still imperfect: Saline load testing remains logistically awkward and variably sensitive, and CT for pneumarthrosis is most discussed for the knee despite thin evidence outside that setting.
• Antibiotic strategy matters: Cefazolin was the usual IV agent in operative care, while cephalexin or clindamycin were common oral choices in nonoperative management, reinforcing that antibiotics remain part of either pathway.
• Resource use difference: Median treatment charges were about $1,089 for nonoperative care versus $11,973 for operative management, but cost should follow clinical risk rather than drive the decision alone.