Traumatic Arthrotomies: Do They All Need the Operating Room?

To compare complications and cost of care in patients with traumatic arthrotomies (TAs) treated with surgical debridement, irrigation, and closure to those treated with nonoperative treatment and local wound care.Design:This is a prospective observational multicenter study.Setting:This study was conducted at multiple Level I trauma centers.Patients:Patients with TAs.Intervention:Patients were treated with operative versus nonoperative management decided by the attending surgeon. Nonoperative treatment of TAs included bedside irrigation, primary closure, antibiotics, and discharge from the emergency department with close follow-up unless admission was otherwise indicated.Main Outcome Measurements:Primary outcomes included adverse outcomes and cost. VR-12 was captured at the time of injury and 3 months postinjury.Results:Of 189 major joint TAs, 64 arthrotomies were treated nonoperatively and 125 operatively. Seventy percent of the arthrotomies in the nonoperative group were small (less than 50 mm in size) and 95% had minimal/no gross contamination, whereas the operative group (OG) had significantly more arthrotomies greater than 50 mm in size and with moderate/severe gross contamination. There was one septic joint in the nonoperative group (1.5%) and 7 in the OG (5.6%). Nonoperative treatment was associated with significantly lower total charges when compared with the OG.Conclusions:Although further study may still be needed, this study suggests that small, minimally contaminated TAs with no associated fracture have a low risk of adverse complications, can safely be treated nonoperatively, and are associated with a significantly decreased cost of care.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.