Joint Injury and Post-Traumatic Arthritis

Excerpt

Nearly 21 million Americans are afflicted with symptomatic osteoarthritis, and an estimated 12% have a post-traumatic etiology, making post-traumatic arthritis (PTA) one of the leading causes of joint disability [4]. Furthermore, recent studies suggest that battlefield orthopaedic injuries represent the majority of long term disability in wounded soldiers in on-going military conflicts, and degenerative arthritis developing following injury is the most common reason for a wounded soldier to be considered unfit for return to duty [6]. Recent developments in injury severity assessment suggest that increasing fracture involvement of the articular surface may be predictive of developing PTA in humans [17]. The unique features of intra-articular fractures include impaction injury to the articular surface, disruption of the osteochondral composite layer, residual displacement of the articular surface, and exposure of the joint to blood and marrow contents. Previous clinical investigation identifies risk factors for the development of PTA as including: residual articular displacement, instability or subluxation of the joint following injury, and/or damage of the articular surface at the time of the injury [1, 5, 7, 12, 16]. At the present time, the state of the art treatment for displaced intra-articular fractures in major weight bearing joints involves anatomic restoration of the articular surface when possible and surgical stabilization of the fracture to allow early range of motion [7]. No pharmacologic intervention (systemically or locally) to the diarthrodial joint has been shown to decrease the incidence of PTA. …