Tibial Plafond Fracture Outcome Effects of Injury Severity and Treatment
Sponsor: Orthopaedic Research and Education Foundation
J. Lawrence Marsh, M.D.
Professor
of Orthopaedic Surgery
The
University of Iowa
Iowa City, IA 52242
e-mail: J-Marsh@uiowa.edu
|
Name |
Organization |
Role on Project |
|
Shepard Hurwitz, M.D. |
University of Virginia
|
Principal Investigator |
|
Thomas DeCoster, M.D. |
University of New Mexico |
Co-Investigator |
|
Douglas Dirschl, M.D. |
University of North Carolina |
Co-Investigator |
|
Scott Smith, M.D. |
University of Tennessee |
Co-Investigator |
Intra-articular fractures are associated with functional deficits and often progress to osteoarthritic joints. The ankle is a weight-bearing joint that rarely develops osteoarthritis without injury and we propose to study the development of arthrosis using displaced tibial plafond fractures as our model. The hypothesis is that injury severity and early motion are independent variables that correlate with patient outcome and the appearance of post-traumatic osteoarthritis. The group of surgeons participating in this project have developed and demonstrated the safety of an articulated external fixator that permits distraction, indirect reduction, percutaneous fixation and ankle motion. This proposal will investigate the role of early active ankle motion in a case-comparison prospective clinical study using several validated outcome measures plus radiographic evidence concerning the injury and subsequent arthrosis. We intend to analyze computerized tomograms from the time of injury to quantify the mechanical injury to the joint and intend to correlate this information with both clinical and radiographic endpoints two years after injury. Our five institutions will enroll 64 patients; they will be surgically treated in identical fashion and randomly assigned to an early motion protocol or remain with a locked ankle for eight weeks. We will collect outcome data plus evaluate radiographs for ankle arthrosis at one year and two years from injury. On completion of this study we will have evidence whether or not surgical treatment combined with early motion results in improved patient outcomes when compared with similarly treated patients whose ankles are immobilized. Also, within each treatment group we will learn more of the clinical outcome due to the severity of the injury. The results of this study will provide evidence for or against early motion treatment of other intra-articular fractures and the prevention of post-traumatic osteoarthritis.