The proposed research aims to convincingly establish new physically-grounded non-invasive techniques to quantify the severity of intra-articular fractures. Post-traumatic osteoarthritis (PTOA) isa frequent and often early complication of treatment, with substantial lifelong morbidity and disability. Theintensity of the initial joint trauma in intra-articular fractures is a critically important factor in the etiology ofPTOA. Interventions to surgically reduce the displaced and fragmented articular surface have beendeveloped and refined over decades. Yet, for some injuries, PTOA remains seemingly inevitable, withsurgical advances unlikely to appreciably change the prognosis. Little is known regarding the biologicalprocesses at work within the joint shortly following these injuries, or how they link joint injury to eventualPTOA. Newly proposed biologic interventions warrant further scientific evaluation, but this will require thatpatient cohorts be reasonably stratified and studied in large enough numbers to yield statistically robustfindings. To stratify patients, the severity of the initial injury must be objectively measured, lest it remain asubstantial confounder that will continue to preclude meaningful investigation. We have developed andvalidated enabling technology to measure fracture severity in a clinical setting.
AIM 1 : We will extend andexpedite this CT-based methodology to better assess articular fractures, implementing new techniques toassess articular fragmentation, fragment dispersal, and the soft tissue injury.
AIM 2 : In a prospective multi-center study we will correlate the expedited injury severity metric with a new computer-based method tocontinually rank order cases for severity, and we will correlate both of these severity metrics with thedevelopment of PTOA.
AIM 3 : We will assay synovial fluid from injured ankles in a prospective study of tibialplafond fracture patients, to gather descriptive data regarding joint damage and recovery in the early post-injury period. These biologic markers will be correlated with the expedited injury severity metric, and each inturn will be correlated with patient outcomes.
TO PUBLIC HEALTH: Patients who sustain fractures that extend into an articular joint, suchas the ankle or knee, have a generally poor prognosis, with eventual arthritis as a common disabling result.Surgeons rely upon subjective empirical experience to guide articular fracture treatment, and this greatlyhinders progress. This study will provide fundamentally new objective non-invasive methods to measurearticular fracture injury severity. These methods will have important clinical implications in their own right,and provide a novel framework for statistically robust clinical/translational studies to reduce the risk ofPTOA.
Showing the most recent 10 out of 99 publications
