The nexus of intra-articular fractures, osteoarthritis and clinical outcome. Does early surgical intervention with anatomical reduction and stabilization of intra-articular fractures improve clinical outcome?

There has been a rapid proliferation, over the last two decades, of the number of products available for osteosynthesis in the treatment of intra-articular fractures. This rapid proliferation is due to a misplaced belief that anatomical reduction and stabilization of intra-articular fractures will reduce the incidence of post-traumatic osteoarthritis (OA) and that post-traumatic OA is invariable associated a poor clinical outcome.

The common belief that OA is a degenerative disease caused by wear of the joint has been debunked. Literature review shows that OA is a disease of all components of the joint and not the articular cartilage alone, where innate immunity plays a significant role.

Some joints that are injured have potential for repair while other joints do not have this potential and joints without potential for repair become prone to OA. Risk factors for OA are known but the relationship between these risk factors and the pathogenesis of OA remains unclear.

Some joints tolerate incongruity better than others; hence it is unnecessary to carry out extensive surgical procedures in joints which tolerate incongruity. Extensive soft tissue dissection which is often necessary for stabilization of fractures is known to cause denervation of joints and denervation of joint is now known to predispose the joint to OA.

Surgery can also be associated with serious complications and is not cost effective where joints tolerate incongruity well. In other joints where incongruity is poorly tolerated all attempts to achieve congruity should be made.

Good clinical outcome is possible despite the presences of OA in some joints. Management of intra-articular fractures should be tailored differently for each joint to achieve the best outcome with minimal complications and it should be cost effective.