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

项目摘要 高能量pilon骨折与创伤后关节炎风险增加相关， 患者结局。关节炎的风险在许多系列中超过25%，在更高的系列中可高达50%。 粉碎性骨折关节内骨折导致滑膜中 炎性细胞因子和基质金属蛋白酶。动物模型已经证明了 持续性关节积血可能对软骨活力造成损害，这表明长期暴露于血液中 在这种高度促炎的环境中，可能进一步加剧来自初始损伤的软骨损伤。 然而，这些局部炎症过程对创伤后关节炎和患者风险的影响 结果仍不清楚。 我们研究的长期目标是开发治疗方式，包括手术和 药物干预，以降低创伤后关节炎和关节内注射后功能障碍的风险 骨折本研究的目的是确定踝关节灌洗对术后并发症风险的影响。 创伤性关节炎和高能量pilon骨折后患者的结局。首先，我们要取滑液 Pilon骨折行临时外固定的患者踝关节样本用于细胞因子检测 分析.然后，我们将患者随机分组，接受标准治疗，有或没有踝关节灌洗， 外固定时间。患者将在最终固定时接受重复的滑液分析 以确定灌洗对促炎细胞因子浓度的影响。最后，患者将 术后随访6个月，以确定对功能结局的影响。 这项研究所产生的信息将大大增加我们对发病机制的理解 高能量pilon骨折的创伤后关节炎

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.