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: 10677836
• 负责人: Benjamin M Wheatley
• 金额: $ 18.43万
• 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/10677836
• 关键词: Adult; American; Amputation; Animal Model; Ankle; Area; Arthritis; Articular Range of Motion; Blood; Blood flow; Caring; Cartilage; Circulation; 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; 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; Risk Reduction; Sampling; Series; Severities; Societies; Swelling; Synovial Fluid; Techniques; Testing; Time; Traumatic Arthropathy; ankle joint; cytokine; foot; functional improvement; 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.

项目摘要 高能pilon骨折与创伤后关节炎的风险增加有关 患者的结果。在许多系列中，关节炎的风险超过25％，高度可以高出50％ 粉碎裂缝模式。关节内断裂导致滑膜浓度的升高 炎性细胞因子和基质金属蛋白酶。动物模型已经证明了不可逆的 损害持续的下摆可能对软骨生存能力可能存在，这表明长期暴露于血液 在这种高度促进的环境中，可能会进一步加剧最初伤害的软骨损害。 但是，这些局部炎症过程对创伤后关节炎和患者的风险的影响 结果尚不清楚。 我们研究的长期目标是开发包括手术和包括手术和 药物干预措施，以减少关节后创伤后关节炎和功能障碍的风险 断裂。这项研究的目的是确定踝关节灌洗对后风险的影响 高能pilon骨折后创伤性关节炎和患者结局。首先，我们将获得滑液 来自经受pilon骨折的暂时外部固定的患者的脚踝关节的样品 分析。然后，我们将随机使患者在有或没有踝关节灌洗的情况下进行标准治疗 外部固定时间。患者将在确定固定时进行重复滑液分析 确定灌洗对促炎细胞因子浓度的影响。最后，患者将是 随后在手术后六个月，以确定对功能结果的影响。 这项研究中产生的信息将大大增加我们对发病机理的理解 高能pilon骨折中创伤后关节炎。