Intraarticular Fracture Discussion

Intraarticular fractures are those in which the break crosses into the surface of a joint. They always result in some degree of cartilage damage. In addition to the usual considerations in fracture management, the relative position of the bone fragments and their relationship to ligament attachments are critical. Ideally, the joint surfaces should be restored to their original position and held there strongly enough that movement may be started in the early postoperative period. This is not always technically possible, and some cases cannot be helped by the most skillful surgery. Some permanent loss of motion is to be expected and the joint may develop degenerative arthritis as a result of the injury. In addition, possible long term problems include presence of a palpable or visible bony prominence, deformity, numbness, weakness, reflex sympathetic dystrophy and others. Less likely problems include re-fracture, compression neuropathy and tendon rupture. Surgical treatment of the fracture may be indicated when the potential risks of surgery are felt to be justified by the potential benefits of improving the alignment of the bones as they heal. Hardware may be required to hold the fracture fragments in position. Even with surgery, the fracture is still prone to the problems noted above in addition to risks of surgery, such as infection, hardware related problems, numbness, tender scars, residual deformity, as well as less common problems such as anesthetic or drug related reactions, among others. Fracture position may shift even after reduction, internal fixation and immobilization. Future removal of hardware may be required. This type of injury may result in degenerative arthritis.

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