Traumatic Arthrotomies: Do They All Need the Operating Room?

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Evidence-Based Medicine

Background:

• Traumatic arthrotomies (TAs) require careful management to minimize complications and control healthcare costs.
• Current treatment paradigms for TAs vary, necessitating a comparison of operative versus nonoperative approaches.

Purpose of the Study:

• To compare the incidence of complications and the cost of care for patients with traumatic arthrotomies (TAs).
• To evaluate operative debridement, irrigation, and closure versus nonoperative treatment with local wound care for TAs.

Main Methods:

• Prospective observational multicenter study involving patients with TAs at Level I trauma centers.
• Patients were managed operatively or nonoperatively based on surgeon decision.
• Nonoperative management included bedside irrigation, primary closure, antibiotics, and close follow-up.

Main Results:

• Of 189 TAs, 64 were nonoperatively treated and 125 operatively.
• Nonoperative group predominantly had small, minimally contaminated TAs; operative group had larger, more contaminated TAs.
• Septic joints occurred in 1.5% of the nonoperative group versus 5.6% in the operative group, with significantly lower total charges in the nonoperative group.

Conclusions:

• Small, minimally contaminated TAs without associated fractures carry a low risk of adverse complications.
• Nonoperative management of select TAs is safe and associated with significantly decreased healthcare costs.
• Further research may be warranted, but current findings support nonoperative treatment for appropriate TA cases.