Development Of Posttraumatic Arthritis Research Articles

7-year follow-up after open reduction and internal screw fixation in Bennett fractures

Bennett fractures are unstable, and, with inadequate treatment, lead to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. This study focuses on long-term functional and radiological outcomes after open reduction and internal fixation. Between June 1997 and December 2005, 24 patients with Bennett fractures were treated with open reduction and internal fixation with screws at our center. Radiological and functional assessments including range of motion of the thumb and pinch and grip strength were performed 4months post-procedure and at the long-term follow-up, on average 83months after surgery. Reduction of the Bennett fracture was maintained as it was at the time of the procedure in 96% of the cases when fixation with two lag screws was performed. At the 4-month follow-up, mean pinch and grip strength reached 92±3 and 89±4% of the contralateral side, respectively. Long-term follow-up demonstrated no correlation between the accuracy of the fracture reduction and the development of post-traumatic arthritis. Good clinical results could be observed, if successful reduction of the fracture was achieved and maintained. However, there was no correlation between the accuracy of the fracture reduction considering a gap and step <2mm and the development of arthritis.

Reconstruction for malunited ankle fractures

Objective To summarize the clinical outcomes of reconstruction of malunited ankle fractures.Methods From January 2006 to October 2009,23 malunited ankle fractures were treated in our department.All deformities were evaluated individually based on pre-operatively X-ray and CT scan.Varying degrees of fibular shortening or rotational deformity were found in all patients,with 4 cases of varus or valgus deformity,and 5 of a widen syndesmosis.Then different reconstructive techniques were chosen according to the type of malunion:a lengthening fibular osteotomy was performed in patients with fibular shortening or rotational deformity;an opening or closing wedge osteotomy was chosen correspondingly in patients with varus or valgus deformity;functional fusion of syndesmosis was performed in cases of widen syndesmosis.The postoperative follow-up included standard radiography to evaluate bone union;relative complications were also recorded and functional outcome were assessed with American Orthopedic Foot Ankle Society (AOFAS)ankle-hindfoot scores.Results Twenty-one patients were followed up with an average period of 36 months (12-58 months).There were no complications of infection,implant failure,nonunion or malunion.Solid union with a favorable alignment was obtained at an average of 12 weeks (10-14 weeks).The mean pre-operative AOFAS ankle-hindfoot score was 28 (15-39).While the score increased to 82 (70-94) one year after operations.But 2 patients underwent ankle arthrodesis correspondingly 18 months and 24 months post-operatively due to severely post-traumatic arthritis.Conclusion An early realignment reconstruction of the length and rotation of fibula and the congruity of ankle mortise may improve the ankle function and slow down the development of post-traumatic arthritis for patients who suffered from malunited ankle fractures. Key words: Ankle; Fractures,malunited; Surgical procedures,operative

Perilunate Dislocations and Transscaphoid Perilunate Fracture–Dislocations: A Retrospective Study With Minimum Ten-Year Follow-Up

Perilunate dislocations and transscaphoid perilunate fracture dislocations are associated with a high incidence of posttraumatic arthritis. According to the current literature, at medium-term follow-up, radiological signs of arthritis do not correlate with functional scores. The aim of this study was to evaluate patient hand function and the development of posttraumatic arthritis after perilunate dislocations (11 cases) and transscaphoid perilunate fracture dislocations (7 cases) at a minimum 10 years of follow-up. A retrospective review was performed including 18 patients with a minimum 10-year (average, 13 y) follow-up. The clinical results were evaluated using the Mayo wrist score and the patient-rated wrist evaluation. Radiological abnormalities were stratified using the Herzberg classification. According to the Mayo wrist score, the authors found 5 excellent, 3 good, 7 fair, and 3 poor results. The mean Mayo wrist score was 76 (range, 60-90). There were 6 type A, 5 type A1, 6 type B1, and 1 type C, according to the Herzberg classification. Posttraumatic degenerative changes were observed in 12 cases. The presence of radiological arthritis and static carpal instability did not cause reduced function at our minimum follow-up of 10 years. Based on our findings and previously reported series, we conclude that signs of posttraumatic arthritis after perilunate dislocations and transscaphoid perilunate fracture dislocations increase progressively but are well tolerated at an average follow-up of 13 years. Therapeutic IV.

Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature

Ankle fractures often have involvement of the posterior malleolus. Treatment guidelines exist based on limited biomechanical evidence and still is considered controversial. The objective of this article is to review the biomechanical literature concerning changes in tibiotalar contract area, changes in contact pressures, changes in ankle stability and incongruency of the joint after a posterior malleolar ankle fracture, and to review the clinical literature concerning the outcome of operative and nonoperative treatment of these fractures. Ultimately, the goal is to try to formulate helpful recommendations for clinical practice. The databases Pubmed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched from 1988 to November 2007 to identify studies relating to changes in tibiotalar contact area, contact pressures, ankle stability, clinical outcome, and radiographic osteoarthritis after a posterior malleolar fracture. The search was restricted to articles written in the English, German, and Dutch language. Eight biomechanical studies, involving 96 cadaveric ankles were included and 10 clinical studies, involving 447 fractured ankles, were included. No consensus in the literature was found as to which fragment size of the posterior malleolus (=posterior tibial margin) should be internally fixed. This is partially because of the lack of standardization in examining functional outcomes, making it difficult to compare results. It is not the peak pressure or changes in tibiotalar contact area, but rather the changes in peak pressure distribution that play a large role in posttraumatic arthritis development. It seems important to restore the medial and lateral constraints of the ankle because these, rather than the articular surfaces, provide the majority of ankle stability after an ankle fracture involving the posterior malleolar ankle fracture.

Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip

We aimed to identify variables associated with clinical and radiological outcome following fractures of the acetabulum associated with posterior dislocation of the hip. Using a prospective database of 1076 such fractures, we identified 109 patients with this combined injury managed operatively within three weeks and followed up for two or more years. The patients had a mean age of 42 years (15 to 79), 78 (72%) were male, and 84 (77%) had been involved in motor vehicle accidents. Using multivariate analysis the quality of reduction of the fracture was identified as the only significant predictor of radiological grade, clinical function and the development of post-traumatic arthritis (p < 0.001). All patients lacking anatomical reduction developed arthritis whereas only 25.5% (24 patients) with an anatomical reduction did so (p = 0.05). The quality of the reduction of the fracture is the most important variable in forecasting the outcome for patients with this injury. The interval to reduction of the dislocation of the hip may be less important than previously described.

Type C 1 and 2 Fractures of the Distal Femur Treated with a Retrograde Nail: Knee Recovery at Six Years Follow-Up

Purpose: The object of this study was to assess the function of the knee joint and the development of post-traumatic arthritis at a minimum of six years in patients in whom an intra-articular distal femoral fracture had been treated with a reamed retrograde intramedullary nail. Methods: This is a retrospective study of thirty intercondylar-supracondylar femoral fractures treated with a reamed retrograde nailing. According to the OTA classification, there were 19 (63 %) type C 1 fractures and 11 (37 %) type C 2 fractures. The operative technique included reduction of the fracture, minimal internal fixation and the insertion of a retrograde interlocked intramedullary nail. Follow-up ranged from 61 to 84 months (average: 72 months). Functional results were assessed using the Neer score and the radiographic appearance of post-traumatic arthritis using the Ahlback score. Results: Fourteen fractures (46.6 %) achieved an excellent Neer score and only three fractures (10 %) a poor Neer score. No correlation was found between the type of fracture and the final score (p = 0.763). No significant correlation was found between the final Ahlback and Neer scores (p = 0.162). Conclusions: A high percentage of radiographic post-traumatic arthritis should be expected after intra-articular femoral fractures that have been treated with intramedullary nailing. However, because all the objectives of the fracture treatment can be obtained, the functional results remain satisfactory over time.

Health Related Quality of Life in Patients with Supination-External Rotation Stage IV Ankle Fractures

While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had "good," and seven had "fair" reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with "good" operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a "fair" operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with "fair" radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

Talar Neck Fractures: Results and Outcomes

Talar neck fractures occur infrequently and have been associated with high complication rates. The purposes of the present study were to evaluate the rates of early and late complications after operative treatment of talar neck fractures, to ascertain the effect of surgical delay on the development of osteonecrosis, and to determine the functional outcomes after operative treatment of such fractures. We retrospectively reviewed the records of 100 patients with 102 fractures of the talar neck who had been managed at a level-1 trauma center. All fractures had been treated with open reduction and internal fixation. Sixty fractures were evaluated at an average of thirty-six months (range, twelve to seventy-four months) after surgery. Complications and secondary procedures were reviewed, and radiographic evidence of osteonecrosis and posttraumatic arthritis was evaluated. The Foot Function Index and Musculoskeletal Function Assessment questionnaires were administered. Radiographic evidence of osteonecrosis was seen in nineteen (49%) of the thirty-nine patients with complete radiographic data. However, seven (37%) of these nineteen patients demonstrated revascularization of the talar dome without collapse. Overall, osteonecrosis with collapse of the dome occurred in twelve (31%) of thirty-nine patients. Osteonecrosis was seen in association with nine (39%) of twenty-three Hawkins group-II fractures and nine (64%) of fourteen Hawkins group-III fractures. The mean time to fixation was 3.4 days for patients who had development of osteonecrosis, compared with 5.0 days for patients who did not have development of osteonecrosis. With the numbers available, no correlation could be identified between surgical delay and the development of osteonecrosis. Osteonecrosis was associated with comminution of the talar neck (p < 0.03) and open fracture (p < 0.05). Twenty-one (54%) of thirty-nine patients had development of posttraumatic arthritis, which was more common after comminuted fractures (p < 0.07) and open fractures (p = 0.09). Patients with comminuted fractures also had worse functional outcome scores. Fractures of the talar neck are associated with high rates of morbidity and complications. Although the numbers in the present series were small, no correlation was found between the timing of fixation and the development of osteonecrosis. Osteonecrosis was associated with talar neck comminution and open fractures, confirming that higher-energy injuries are associated with more complications and a worse prognosis. This finding was strengthened by the poor Foot Function Index and Musculoskeletal Function Assessment scores in these patients. We recommend urgent reduction of dislocations and treatment of open injuries. Proceeding with definitive rigid internal fixation of talar neck fractures after soft-tissue swelling has subsided may minimize soft-tissue complications.

Remodeling of articular defects in an animal model.

When treating displaced intraarticular fractures, the goal has been to restore normal articular cartilage contour to decrease local contact stresses that may lead to the development of posttraumatic osteoarthritis. To confirm observations that articular cartilage step-offs can remodel with time and to determine how the articular surface and subchondral bone remodels after an intraarticular fracture, joint surface changes were examined in a weightbearing sheep model with an intraarticular fracture. Articular surface pressure changes were observed across a 1-mm osteotomy. Twelve weeks after an intraarticular osteotomy, there was a decrease in differential pressure distribution between the normal articular cartilage and the depressed articular surface. Histologic analysis showed thinning of the articular cartilage on the high side of the osteotomy with collagen compression and bending of the collagen fibrils. On the low side of the osteotomy, increased chondrocyte cellularity and hypertrophy were observed. In addition, bending of collagen fibrils was observed in an unloaded state in an attempt to form a smooth overlapping shelf at the osteotomy site. Because intraarticular incongruency, with resultant joint contact pressure differences, seems to be involved in the development of posttraumatic arthritis, methods to improve cartilage remodeling may improve outcome after intraarticular fractures.

Autograft Replacement of Small Joint Defects in the Hand

Intraarticular injuries to the small joints of the hand with attendant loss of cartilage can result in the development of posttraumatic arthritis with functional disability due to pain and loss of motion. Traditional treatment options often have yielded suboptimal results in terms of functional return, particularly when applied once contracture or arthritic change already has developed. Acute management of cartilage loss by osteochondral reconstruction with restitution of the articular surface may diminish the likelihood or severity of potential post-traumatic degenerative changes.

The Cervical Synovial Joints as Sources of Post-Traumatic Headache

Objectives: To describe recent research which elucidates the role of the cervical synovial joints are innervated and that they can be potent sources of neck pain and headache if stimulated in normal subjects of if injured in patients. Pastmortem studies of injured points have revealed chondral and subchondral fractures, bruising/damge of the intra-articular inclusions, hemarthroses and capsular tears or avulsions. These acute lesions constitute the substrate for the development of posttraumatic arthritis and, consequently, chronic post-traumatic headache. Such lesions evade detection by conventional diagnostic techniques. However, the advent of innovative diagnostic approaches, including manipulative assessment, biomechanical analysis and controlled diagnostic injection techniques, has allowed the identification of painful cervical synovial joints in vivo. Using these diagnostic techniques, epidemiological studies have shown that the cervical zygapophysical joints [in particular C2-3] are common sources o...

Fractures and fracture-dislocations of the tarsometatarsal joint.

We are reporting the results in a consecutive series of forty adults in whom, between 1978 and 1984, forty-one tarsometatarsal fracture-dislocations were treated with open reduction followed by temporary internal fixation with AO screws. Ninety per cent of the patients had an intra-articular or a periarticular fracture. An anatomical or nearly anatomical reduction was achieved in all but a few patients, and there was no loss of fixation or displacement. For thirty-four patients (thirty-five injuries), the length of follow-up averaged 3.4 years, and a good or excellent functional result was obtained in all but two of the thirty in whom an anatomical reduction had been achieved. Of the six patients who had a fair or a poor result, five had an associated grade-II or grade-III open injury. The development of post-traumatic arthritis was directly related to damage to the articular surfaces or to inadequate reduction, or to both.