Ankle Fractures: The Physiological Cost of Waiting
by Vince Vacketta, DPM
New research evaluating the significance of synovial fluid fracture hematoma (SFFH) and chondrocyte damage may change the way we approach intra-articular fractures in both timing and management.
A recent article titled "Exposure of Tissue-Engineered Cartilage Analogs to Synovial Fluid Hematoma After Ankle Fracture Is Associated With Chondrocyte Death and Altered Cartilage Maintenance Gene Expression," authors Allen et. al. studied the effects of SFFH on a synthetic chondrocyte model were evaluated. The research demonstrated significant negative downstream effects, ultimately leading to chondrocyte differentiation towards an osteoarthritis phenotype. The implications of this observed chondrocyte differentiation may result in a more rapid progression of post-traumatic osteoarthritis, despite appropriate fracture repair.
These results advocate for early management of intra-articular ankle fractures and further reinforce the benefits of arthroscopic joint lavage. In scenarios of soft tissue limitations consider early arthroscopic lavage and external fixation when appropriate.