Intra-articular fractures are particularly likely to lead to post-traumatic osteoarthritis. Whenever a fracture line extends across the articular surface, the articular cartilage is permanently damaged. The amount of injury can be minimized by anatomic reduction of the articular surfaces. Therefore, virtually all displaced intra-articular fractures require open reduction and rigid internal fixation of the articular fragments to restore joint congruity. However, even if joint congruity is re-established, the cartilage injury does not fully heal. The smooth hyaline cartilage of the articular surface cannot regenerate, and a fracture through the hyaline articular cartilage is repaired with fibrocartilage. Fibrocartilage does not have the mechanical strength or durability of hyaline cartilage. When this reparative fibrocartilage is subjected to repeated stresses, it wears out, also leading to post-traumatic osteoarthritis. The arthritis may develop in the first few months after fracture healing, or it may develop insidiously with time as the articular surface gradually wears away. Arthritic symptoms may appear 15 to 20 years after the injury.
Conservative management is adequate for mild post-traumatic osteoarthritis. These measures include limitation of activity, avoidance of stress, use of braces and other support devices for walking, and administration of nonsteroidal anti-inflammatory drugs (NSAIDs). Severe, disabling osteoarthritis of the hip, knee, or shoulder is treated with total joint replacement. With advancements in technology, total elbow and total ankle replacements are also becoming possibilities in select circumstances. Total joint replacement restores joint motion and relieves pain by replacing the articular surfaces with plastic and metal prostheses. Arthrodesis (fusion) of the joint is the preferred treatment of severe post-traumatic arthritis in other joints, particularly the ankle joint and the small joints of the foot and hand. However, although a successful arthrodesis eliminates pain in the arthritic joint, it also sacrifices joint motion.
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