The Development of Posttraumatic Arthritis After Articular Fracture

Abstract

Posttraumatic arthritis (PTA) is one of the most frequent causes of disability after trauma involving weight-bearing joints and is estimated to be responsible for approximately 10% of the 21 million Americans who have osteoarthritis. Despite a number of similarities in the pathology and end-stage disease of PTA with primary osteoarthritis, the mechanisms involved in the onset and progression of joint degeneration after articular fracture are poorly understood. The largest area of study regarding articular fractures and the development of arthritic changes has focused on the role of adequate surgical reduction of the articular surfaces. However, it is now apparent that a number of complex and interacting biomechanical, biochemical, and, possibly, genetic factors contribute to the development of osteoarthritic changes in the joint after joint trauma, ranging from the cell and molecular level to the joint and systemic level. In this paper, we discuss the potential roles of the initial impact and fracture as well as the subsequent alterations in joint loading, biomechanical and metabolic properties of the cartilage, local and systemic inflammatory cytokines, and viability of chondrocytes in the progression of PTA. An improved understanding of the mechanisms involved in the development of PTA will hopefully lead to the improvement of surgical and nonsurgical therapies for this disease.

Biglycan and Fibromodulin Have Essential Roles in Regulating Chondrogenesis and Extracellular Matrix Turnover in Temporomandibular Joint Osteoarthritis

“…Tissue sections were stained histochemically with hematoxylin and eosin (H&E), toluidine blue, or Safranin O. A semiquantitative histological scoring system, based on a modified Mankin system, 32 was used to investigate degenerative changes in the mandibular condylar cartilage. Comparable H&E sections from wild-type and Bgn…”

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

“…However, not all factors that influence orthopaedic surgical outcomes are amenable to expert visual evaluation, and these factors may be equally or more important than directly observable technical expertise. For instance, in the case of intraarticular fracture reduction, performance evaluation should consider the precision with which the joint is restored, an important factor in determining the likelihood of posttraumatic osteoarthritis [2,4]. Similarly, in the case of extraarticular fracture reduction, performance evaluation should consider the strength of the associated fixation construct, because the construct serves to maintain the reduction during the course of early recovery and its mechanical integrity substantially influences fracture healing [14].…”

Absence of posttraumatic arthritis following intraarticular fracture in the MRL/MpJ mouse

“…Additionally, disruption and impaction of the articular surface can lead to chondrocyte necrosis or apoptosis (10)(11)(12). In particular, there is growing evidence that proinflammatory cytokines such as interleukin-1 (IL-1) or tumor necrosis factor ␣ (TNF␣) are up-regulated in the joint following trauma, and thus may play an important role in the pathogenesis of posttraumatic arthritis (13,14), similar to their role in primary OA (15,16).…”