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Pathomechanics of Post-Traumatic OA Development in the Military Following Articular Fracture

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Technical Report,30 Sep 2016,29 Sep 2017

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The University of Iowa Iowa City United States

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The objective of this research is to develop new models for predicting the risk of post-traumatic osteoarthritis PTOA following intra-articular fracture IAF. We have analyzed pre- and post-treatment CT data from patients with combat-related IAFs to measure fracture severity and post reduction contact stress exposure. Our partner at SAMMC continues screening the DoDTR to identify and enroll subjects. The imaging data for 57 subjects with collectively 95 fractures have been forwarded to us for analysis, and we have completed fracture severity analysis of 71 IAFs. This is in addition to fracture energies having now been computed for 226 civilian IAFs. In a preliminary analysis of our military data, we found that fracture energy can predict painful and activity-limiting PTOA, which contributes to late amputation in military blast injuries. Twenty military subjects with tibial pilon IAFs resulting from blast injuries were studied. Of the 15 subjects with sufficient follow-up data, 5 limbs were amputated. There was a statistically significant difference in the fracture energies of the amputation and retained limb groups 17.4 vs 6.6 J, respectively p0.0059. An objective fracture severity score nearly perfectly predicted amputation. During the coming year, we will be performing additional analysis of fracture severity in more cases to further test these findings.

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  • Medicine and Medical Research

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