Does joint lavage reduce intraarticular inflammation in high-energy tibial pilon fractures?

关节灌洗是否可以减少高能胫骨骨折时的关节内炎症？

• 批准号: 10444639
• 负责人: Benjamin M Wheatley
• 金额: $ 8.98万
• 依托单位: HENRY M. JACKSON FDN FOR THE ADV MIL/MED
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444639
• 关键词: Adult; American; Amputation; Animal Model; Ankle; Area; Arthritis; Articular Range of Motion; Blood; Blood Circulation; Blood flow; Caring; Cartilage; Comminuted Fracture type; Development; Elbow; Enzyme-Linked Immunosorbent Assay; Exposure to; Fracture; Functional disorder; Goals; Hemarthrosis; Immobilization; Impairment; Implant; Infection; Inflammation; Inflammatory; Injury; Intervention; Irrigation; Joints; Knee; Lead; Mann-Whitney U Test; Matrix Metalloproteinases; Modality; Operative Surgical Procedures; Orthopedics; Outcome; Pathogenesis; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Pharmacologic Substance; Postoperative Period; Process; Prognosis; Randomized; Research; Risk; Sampling; Series; Severities; Societies; Swelling; Synovial Fluid; Techniques; Testing; Time; Traumatic Arthropathy; ankle joint; cytokine; foot; functional outcomes; healing; improved; inflammatory milieu; joint injury; nutrition; radiological imaging; sample fixation; soft tissue; standard care; standard of care; surgery outcome; treatment group; wound

PROJECT SUMMARY High-energy pilon fractures are associated with an increased risk of post-traumatic arthritis and poor patient outcomes. The risk of arthritis is over 25% in many series and can be upwards of 50% in more highly comminuted fracture patterns. Intraarticular fractures result in an increase in the synovial concentrations of inflammatory cytokines and matrix metalloproteinases. Animal models have demonstrated the irreversible damage a persistent hemarthrosis may have on cartilage viability suggesting that prolonged exposure to blood in this highly pro-inflammatory milieu may further exacerbate the chondral damage from the initial injury. However, the impact of these local inflammatory processes on the risk of post-traumatic arthritis and patient outcomes remain unclear. The long-term goal of our research is to develop treatment modalities including surgical and pharmaceutical interventions to reduce the risk post-traumatic arthritis and dysfunction following intraarticular fractures. The objective of this study is to determine the effect of ankle joint lavage on the risk of post- traumatic arthritis and patient outcomes following high-energy pilon fractures. First, we will obtain synovial fluid samples from the ankle joint of patients undergoing temporary external fixation of a pilon fracture for cytokine analysis. Then, we will randomize patients to undergo standard treatment with or without ankle joint lavage at the time of external fixation. Patients will undergo repeat synovial fluid analysis at the time of definitive fixation to determine the effect of lavage on the concentration of pro-inflammatory cytokines. Last, patients will be followed for a period of six months after surgery to determine the impact on functional outcomes. The information generated in this study will substantially add to our understanding of the pathogenesis of post-traumatic arthritis in high-energy pilon fractures.

项目总结