Should We Worry? Clinical Characteristics and Outcomes of Pediatric Traumatic Arthrotomies

Traumatic arthrotomies are rare, urgent injuries that carry high presumed risks for joint contamination and septic arthritis (SA). Most of these injuries occur in the knee. Like open fractures, treatment typically involves prompt antibiotic administration followed by surgical irrigation, debridement, and closure. Unlike open fractures, there is sparse evidence guiding pediatric arthrotomy management. This study aimed to characterize the demographics, clinical management, and outcomes of pediatric traumatic arthrotomies of the knee and other joints.

Children with confirmed traumatic arthrotomy diagnoses admitted to the emergency department at a level 1 pediatric trauma center between 2013 and 2023 were retrospectively reviewed. Patient demographics, clinical characteristics, and outcomes were summarized using descriptive statistics. Postoperative complications were analyzed, along with 95% confidence intervals calculated using the Clopper-Pearson method.

Our cohort consisted of 36 patients (75% male, 68% White, average age 10 years, 58% privately insured). Traumatic arthrotomies most frequently resulted from falls (44%) and occurred in the knee joint (89%). The median time from admission to the operating room was 9 h (r, 2-45), with antibiotics initiated after a median of 4 h (r, 0-16) and continued for a median of 6 d (r, 0-24). Most patients (92%) underwent open irrigation and debridement with a median irrigation volume of 6 L (r, 1-9 L), and drain placement was used in 8 patients (22%). Forty-four percent of patients with a knee arthrotomy had an associated deep structure injury requiring repair. Four patients (11%) required reoperation for complex soft-tissue management, and three (8%) experienced noninfectious complications. Two patients developed superficial infections (5%); no cases of deep infection/SA were observed. Median duration of joint immobilization was 14 d (r, 0-59), and median time to return to full range of motion was 45 d (r, 6-93). Median time to clearance for full activity was 40 d (r, 12-153).

Following a traumatic arthrotomy, most children achieve complete, uncomplicated recoveries. We report an absence of deep infection and a low superficial infection rate, none of which occurred in the knee. However, surgeons should remain vigilant in assessing for associated soft-tissue injuries.

(1)In this investigation, we found that there is a very low risk of deep infection or septic arthritis in children with traumatic arthrotomies (0% in our series) when applying the standard of care of timely antibiotic administration and surgical irrigation and debridement of the joint.(2)There was a high rate of structural soft-tissue injury that required repair (i.e., patellar/quadriceps tendon laceration) in traumatic arthrotomies of the knee.(3)Most children experience full recovery and return to sport around 6 weeks after traumatic arthrotomy.

Level IV, case series.