INTRA-ARTICULAR FRACTURE
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Intra-Articular Fracture
Intra-articular fractures refer to fractures in which the fracture line penetrates the joint surface, causing some cartilage injury. Also, the fractures might range from displaced to hairline fractures. Usually, intra-articular fractures should be anatomically minimized and secured firmly to permit early joint mobility. Where not possible, some permanent loss of mobility can occur, and the damage may cause the joint to develop degenerative arthritis. Furthermore, other issues that could arise include reflex sympathetic dystrophy, bony protrusion, deformity, numbness, and others.
Intra-articular Fractures Commonly Occur in the Following Areas:
Shoulder
Might affect the glenoid and articular cartilage, and also the humerus, scapula, acromion, and coracoid processes.
Hip
It could also affect the articular cartilage of the hip and a piece of the pelvis, as well as the head, upper neck, or head of the femur.
Elbow
It can affect the lower end of the humerus, the upper end of the radial and ulnar collateral ligaments, and the cartilage between the bones.
Wrist
It can affect the lower ends of the radius and ulna, the carpal bones, and the cartilage between the smaller carpal bones.
Knee
It can affect the lower edge of the femur, the patella, the upper edge of the tibia and/or fibula, and the articular cartilage and collateral ligaments.
Ankle
It may involve the lower edge of the tibia or fibula, the subtalar joint and articular cartilage, the anterior tibiofibular ligament, and the lateral collateral ligament.
QUESTIONS AND ANSWERS
What constitutes an intra-articular fracture in children, and how does it differ from other types of fractures?
Intra-Articular Fracture: An intra-articular fracture refers to a type of fracture where the break occurs within the joint itself or extends to the joint surface. These fractures appear more complex because they affect the articulating surface of the bone, potentially leading to joint instability, cartilage damage, and long-term joint problems.
How do doctors diagnose and treat intra-articular fractures in children?
- Diagnosis: Doctors normally diagnose Intra-articular fractures through a combination of clinical examination and imaging studies such as X-rays, CT scans, or MRI scans. These tests help assess the location and severity of the fracture, as well as its impact on the joint.
- Treatment: The treatment approach for intra-articular fractures in children varies depending on the specific fracture, the child’s age, and other factors. Treatment options may include closed reduction (non-surgical realignment), open reduction (surgical realignment), and fixation with hardware such as screws or pins. The surgeon’s goal restores the joint’s alignment and provides stability while minimizing damage to the joint surface.
What is the long-term outlook for children with intra-articular fractures, and can complications be prevented?
- Long-Term Outlook: The long-term outlook for children with intra-articular fractures depends on various factors, including the type and location of the fracture, the quality of treatment, and the child’s age. Intra-articular fractures can potentially lead to complications such as post-traumatic arthritis or joint stiffness. Regular follow-up with a healthcare provider and adherence to rehabilitation and physical therapy will improve the child’s joint function.
- Complication Prevention: While some complications may be unavoidable, appropriate and timely treatment and rehabilitation can help minimize the risk of long-term joint problems. Following the healthcare provider’s recommendations for activity restriction and physical therapy can also contribute to a better outcome.
Intra-articular fractures in children require careful evaluation, prompt treatment, and long-term follow-up to ensure the best possible outcome and prevent complications. It’s crucial for parents and caregivers to consult with a pediatric orthopedic specialist or a healthcare provider experienced in pediatric fracture care to develop an individualized treatment plan and provide the child with the best chances for a full recovery.
The doctors at Medical City Children’s Orthopedics and Spine Specialists, are experts in treating intra-articular Injuries. To ensure your child’s bones heal properly, call us for an appointment
Causes
- Blunt force trauma
- Automobile accidents
Symptoms
- Pain
- Limited use or range of motion
- Weakness
- Swelling
- Bruising
Diagnosis
- Visual observation
- X-rays
- CT scans
- MRI
Diarthrodial joints enable the appendicular skeleton’s bones to articulate smoothly and securely, enabling them to perform certain functions. Accordingly, the two end segments of a bone are joined by a fibrous capsule to form a synovial joint. Hyaline cartilage, which is supple, elastic, but avascular, covers the bone’s articulating end portion. Overall, cartilage aids in distributing forces to the subchondral bone underneath. At various joint motion locations, various surfaces of the joint come into touch. Therefore, the joint’s capsule, surrounding muscles and tendons, ligaments, and form all work together to support the joint. Overall, the surfaces of the articular cartilage are lubricated and fed by synovial fluid. Finally, joint health depends on joint movement and repeated physiological loads.
Mechanism of Intra-articular Injury
Articular fractures often result from one of two damage mechanisms:
Indirect Forces
Ligaments provide resistance to the force that causes a bending moment, which changes the eccentric load into a direct axial overload and fractures the joint surface. Henceforth, the most frequent cause of intra-articular fractures is this mechanism. Usually, a partial articular fracture arises from this. Evidently, a split or shearing fracture often gets caused by loading one side of the joint, whereas an avulsion fracture or torn ligament typically becomes caused by pulling on the ligamentous insertions on the opposing side.
Direct Forces
Axial loading forces cause one component to operate as a hammer on the other, impinging on the articular surface or, in more extreme cases, impinging with fractures to the metaphysis or even diaphysis. The fracture pattern depends on the kind of bone, the bone’s location, and the direction and magnitude of the force. Because of the damage that results from this, multi-fragmentary intra-articular fractures can occur. This injury compares to crushing. Serious soft tissue injuries are often related.
Evaluation of Intra-articular Fractures
In the event of high-energy injuries, doctors should examine the patient for related musculoskeletal and non-orthopedic injuries. Nevertheless, many systems or multiple bones can get damaged. Basically, Intra-articular fractures can result in joint subluxation or dislocation as well as severe deformities of the limb. To exclude any neurological or vascular damage, our doctors believe a thorough neurovascular evaluation should occur. Examining any accompanying compartment syndrome should occur.
Treatment of Intra-articular Fractures
Adult fractures that need restoration of the articular surface require early anatomical reconstruction, stable fixation with interfragmentary compression, and early mobility.
Intra-articular Fracture Guiding Principles
The intra-articular fractures may cause stiffness, deformity, discomfort, and posttraumatic arthritis, according to the current operating room philosophy. Certainly, securing an anatomical reduction of the articular surface, reestablishing joint stability and correct axial alignment, and initiating early mobility are critical to prevent deformity and stiffness. Consequently, animal studies show that sustained passive motion followed by anatomical reduction and stable fixation with interfragmentary compression of an intra-articular fracture promotes hyaline cartilage repair. In addition, it is generally recognized that surgeons can repair an articular cartilage defect through the development of fibrous cartilage.
The following identifies the basic principles of treating intra-articular fractures:
- Joint stiffness comes from the immobilization of intra-articular fractures using a plaster cast.
- Increased stiffness occurs as the outcome of immobilizing intra-articular fractures using a plaster cast, open reduction, and internal fixation.
- Closed manipulation and traction influence depressed articular fragments but do not diminish them.
- The instability that comes from their displacement in major articular depressions appears permanent because they do not fill with fibrocartilage.
- To restore joint congruency, doctors should reduce and securely fix articular fragments.
- To stop the repositioning of the decreased articular segments, surgeons must repair the metaphyseal deficiencies beneath them with a structural bone graft or replacement.
- In order to position the limbs properly and avoid joint loading, the surgeon should displace and decrease metaphyseal and diaphyseal.
- To avoid joint stiffness and guarantee articular healing and recovery, doctors should allow mobility. This calls for reliable internal fixation.
Non-operative Treatment
Many different fractures might benefit from this therapy. Presently, the conventional course of therapy requires early mobility after immobilization.
Surgery Should Begin Shortly After Intra-articular Damage
- Open fractures
- Irreducible fracture-dislocations
- Linked with neurovascular injuries
- Articular fractures related to compartment syndromes
Severe soft tissue damage normally occurs in intra-articular fractures, and as a result, surgeons will postpone operations until healing occurs. Delays might range from a few days to two or three weeks. If an excessive amount of delay occurs, the surgeon knows that restoring the joint as quickly as possible will ensure a faster and better result. In these situations, guarantees the reduction of the articular surfaces while exposing as little skin as possible during external fixation. Aligning and fixing articular fragments should only need minor surgery, and lag screws frequently act as implants. When the delay is expected, any metaphyseal fracture or deformity is not addressed at this stage. Both intra-articular and metaphyseal procedures are performed at the same time in situations when the soft tissue conditions appear good and recovery is possible in 5-7 days.
Mechanism and Procedure for Fixing Intra-articular Fractures
Preserving the blood flow to all of the bone pieces and the soft tissues provides the strategy for the successful repair of articular injuries. Surgeons accomplish this goal by staging intra-articular and metaphyseal procedures, indirect reduction methods, percutaneous lag screw insertion, and, if necessary, the buttressing of these fractures in hybrid frames. It goes without saying that the skin should appear healthy at the time of surgery. The initial surgical procedure for reconstructing intra-articular fractures involves anatomical reduction of the articular surface. The articular cartilage’s depressed areas need raising and repairing.
After the articular fragments are dis-impacted and raised, surgeons will use a bone transplant to repair the metaphyseal defect that remains. In these circumstances, autogenous cancellous bone remains the ideal. To prevent axial overload, surgeons must buttress the metaphysis and the diaphyseal components must undergo repair in order to initiate early motion. Before closure, the surgeon should repair other intra-articular structures. In cases of compartment syndrome, vascular repairs, open fractures, etc., hybrid external fixation may be used instead of the typical use of plates for buttressing. It’s crucial to avoid tensing up the skin. Closing the synovium and capsule would protect the articular cartilage from drying out and would also cover any exposed tendon or nerve. After five days, some wounds need secondary closure. Surgeons consider using Skin-covering flaps when skin closure does not appear as an option.
Conclusion
A child’s broken joint requires treatment by an orthopedic surgeon who understands the complex workings of the bones, tendons, ligaments, and muscles. Medical City Children’s Orthopedics and Spine Specialists with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX are familiar with the latest surgical techniques for even the most difficult fractures to treat, including complex unhealed fractures. Our orthopedic specialists provide individualized treatment programs that cover every aspect of your care, including diagnosis, treatment, rehabilitation, and aftercare. The type of fracture your child has and the location of the injury will determine your course of treatment.
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Footnote:
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