Mechanical Determinants of Post-Traumatic Arthritis in Tibial Pilon Fractures
Sponsor: The Arthritis Foundation

Thomas D. Brown, Ph.D.
Richard C. Johnston Chair of Orthopaedic Biomechanics
The University of Iowa

Iowa City, IA 52242
e-mail: Thomas-Brown@uiowa.edu

Name	Organization	Role on Project
J. Lawrence Marsh, M.D.	University of Iowa	Co-Investigator
Nicole M. Grosland, Ph.D.	University of Iowa	Co-Investigator
Donald D. Anderson, Ph.D.	University of Iowa	Co-Investigator

Post-traumatic osteoarthritis is a very frequent complication of bone fractures that involve articular joints. Even when the bone fracture itself heals satisfactorily, the articular cartilage can nevertheless degenerate, resulting in pain and loss of mobility. This often progresses to the point of requiring major reconstructive surgery, such as total joint replacement. The reason(s) for this cartilage degeneration are controversial. Many surgeons and scientists believe the main problem is that if the fracture fragments do not reunite precisely, in terms of restoring smooth congruency of the joint surface, portions of the cartilage will be chronically subjected to elevated mechanical stress, and therefore will progressively degenerate. If this is true, then no effort should be spared to very precisely align fracture fragments, even if this requires a very extensive surgical procedure just after the injury. Other surgeons and scientists believe that the cause of post-traumatic osteoarthritis is that during the instant of the original injury the cartilage had to transmit an/or absorb a very strong pulse of mechanical energy, and that the cartilage and its cells therefore suffered acute irreversible damage, becoming destined to degenerate regardless of the precision of joint surface restoration. If this is true, then extensive surgery to precisely realign fragments would needlessly subject already-injured tissues to yet additional insult, risking complication, such as limb loss. We plan to study which of these two possibilities best explains the instance of post-traumatic osteoarthritis occurring in a multi-center series of 80 patients who have suffered sever fractures of the tibial side of the ankle, know as plafond fractures. For this purpose, new laboratory biomechanical techniques have been developed to measure the severity of the acute energy pulse, based on digital image analysis of the fracture pattern. And, new computational stress analysis techniques have bee developed to quantify the severity of chronic stress elevation at the fracture site.

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