Major Pro-inflammatory Response With Intra-articular Ankle Fractures

Researchers from Duke University and the University of Rochester have made progress in determining what is going on with patients who have intra-articular fractures and—even after anatomic fracture reduction—develop ankle arthritis.

Twenty-one patients with an intra-articular ankle fracture were included in this study. The research team set out to characterize the inflammatory cytokine and matrix metalloproteinase (MMP) composition in the synovial fluid of patients with these fractures.

Samuel Adams, M.D. is assistant professor of Orthopaedic Surgery and director of Foot and Ankle Research at Duke University Medical Center. He told OTW, “This work was performed because despite excellent reduction of ankle fractures, a large majority of intra-articular fractures develop ankle arthritis. Therefore, there must be other forces at play. This study demonstrated that at the time of injury there is a large pro-inflammatory response in the ankle joint. While this study does not correlate this inflammatory response to ankle arthritis, we hypothesize that this initial inflammation can initiate an inflammatory cascade of cartilage damage and synovitis. Most readers may question the fact that ‘inflammation’ is the first step in healing of all tissues. This is true, but one must remember that the inflammation healing response is intended for the fractured bone and not the healthy cartilage and synovium in the ankle joint that is in direct communication with the fracture healing. I recommend a thorough irrigation of the joint at the time of fracture fixation or a needle or arthroscopic lavage at the time of external fixation to reduce the inflammatory burden.”