Traumatic ankle osteoarthritis is a disease caused by trauma, in which degeneration of articular cartilage and secondary cartilage proliferation and ossification are the main pathological changes, and joint pain and dysfunction are the main clinical manifestations.
Etiology
1.Violent trauma: such as falling pressure, impact, etc., causing fractures, cartilage damage, intra-articular foreign body storage, etc., so that the joint surface is not flat, so that it suffers abnormal wear and tear and destruction.
2, weight-bearing imbalance: such as congenital and acquired deformities of the joint (such as internal and external knee, ankle joint tilt, tumors, etc.) and the backbone fracture into an angular deformity healing, so that the joint weight line is not correct, the joint surface at the long-term pressure suffered excessive wear and tear and damage.
3, excessive weight-bearing sports: such as some occupations require some joint activities of the muscle body to be frequent or often take a specific posture, or heavy obesity, or unilateral limb weight-bearing after amputation, etc., can cause cumulative injury, resulting in excessive wear and tear of the joint surface of the corresponding joint.
Clinical manifestations
Intra-articular fractures, which are intra-articular capsule fractures involving the joint, are most common in the elbow joint, including the inner and outer humeral condyles or intercondylar fractures. This is followed by the ankle joint, including ankle and talus fractures. The knee joint, including the femoral condyle, tibial condyle and patellar fracture, is the next most common. Injury to the articular cartilage is one of the most common causes of traumatic arthritis. The disease can occur in any age group, but is more common in young adults, mostly in the post-traumatic, weight-bearing imbalance and excessive weight-bearing joints.
Early clinical manifestations: pain and stiffness of the affected joints, which are more obvious at the beginning of activity, reduced after activity, aggravated after more activity, and relieved after rest, with a clear relationship between pain and activity.
2.Late clinical manifestations: repeated swelling of the joint, pain persists and gradually worsens, restricted activity, joint effusion, deformity and intra-articular free bodies may appear, and rough friction sounds appear when the joint is moved.
Physical signs.
1, gait: different conditions can have their own special pathological gait traumatic arthritis for anti-pain gait, that is, when walking, when the affected foot on the ground, due to weight-bearing pain and quickly replace the healthy foot to start, in order to reduce the weight, so the affected limb stride small, healthy limb stride large.
2.Deformity: deformity of the lower limb can occur due to the change of weight-bearing force.
Diagnosis
1.History of chronic accumulative joint injury or history of obvious trauma, with slow onset.
2.Early affected joints are sore and painful with a feeling of motion stiffness, which improves after activity, but the symptoms are aggravated again after overwork.
3.Later joint pain is related to the activity, rough rubbing sensation may appear when moving, joint interlocking or intra-articular free body may appear, and joint deformation.
4.X-ray examination shows that the joint space is narrowed and the subchondral articular surface is hardened and there are bone spurs of varying degrees at the edges of the joint. In late stage, joint surface irregularity, bone end deformation and intra-articular free body may appear.
Differential diagnosis
1.Osteoarthritis
2.Rheumatoid arthritis
3.Large osteoarthrosis
Treatment
1.Non-surgical treatment.
① Correct deformity and prevent degeneration of articular cartilage: traumatic arthritis is a late complication of fracture displacement and articular cartilage fracture, so late deformity can be caused by deformity healing or can be caused by developmental disorders after normal healing, and should be very familiar with those fracture sites that are prone to deformity healing and the way they are displaced.
② Medication: Adjunctive treatment with medication can reduce symptoms There are many anti-inflammatory and analgesic drugs commonly used in clinical practice. Corticosteroids should be prohibited in the treatment of arthritis because they inhibit proteoglycan synthesis in articular cartilage.
③Physiotherapy.
2.Surgical treatment.
①Joint cleanup is suitable for cases where the free body edge bone spur is more obvious in the joint, but the weight-bearing surface of the joint is still relatively intact.
Osteotomy is suitable for obvious intra-articular and exostosis and fracture with obvious angular deformity healing. Osteotomy can reduce the intra-articular pressure, correct the gravity line and make the more intact joint surface bear more weight load.
(iii) Joint fusion is suitable for patients with a single weight-bearing lower extremity joint with severe joint destruction who are relatively young and need to perform walking or standing work. Our foot and ankle surgery department can perform ankle joint fusion with the assistance of ankle arthroscopy, which is a small incision, less trauma, and quick recovery after surgery.
④ Artificial ankle joint replacement is suitable for elderly people with severe pain and joint destruction. Patients do not have pain when walking on the ankle joint after surgery and have a certain range of joint movement.