Does Joint Lavage Reduce Intraarticular Inflammation in High-energy Tibial Pilon Fractures?
United States Naval Medical Center, San Diego
Summary
High-energy tibial pilon fractures have historically been associated with poor outcomes largely due to the elevated risk of severe post-traumatic arthritis. Intraarticular fractures result in a pro-inflammatory hemarthrosis that may further exacerbate the chondral damage that was sustained due to the original injury. This project will study the effect of joint lavage on the concentration of inflammatory cytokines in the ankle following a high-energy tibial pilon fracture and the resultant effect on short-term patient outcomes.
Description
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…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * Male or female age 18 years or older * Present with an axially unstable tibial pilon fracture requiring temporary external fixation followed by delayed definitive internal fixation * Able to give informed consent Exclusion Criteria: * Open fractures * Delayed presentation greater than 72 hours post-injury * Associated talar body fracture * Presentation after initial ex-fix placement * Unreconstructable or unsalvageable joint * Preexisting ankle arthritis * Previous ankle surgery * Contralateral ankle injury * Age less than 18 years * Pregnant women * Individuals who ar…
Interventions
- ProcedureJoint Lavage
An arthrotomy will be made at the time of temporary external fixation and 1L normal saline will be used to irrigate the ankle joint.
Location
- Brooke Army Medical CenterFort Sam Houston, Texas