Scott W. Wolfe, M.D.

Featured Investigator and Recipient of a Pilot and Feasibility Project Award

Scott W. Wolfe, M.D.

Scott W. Wolfe, M.D.

The Relationship of Articular Cartilage Impaction Injury and Articular Surface Stepoff to the Development of Degenerative Arthritis in an In Vitvo Intraarticular Fracture Rabbit Model

Scott W. Wolfe, M.D. is a Professor of Orthopaedics and Rehabilitation.

Fractures of the distal radius account for over 15% of all skeletal injuries. Inadequate or imprecise restoration of the anatomic alignment of the distal radius can result in loss of congruency of the articular surface, and abnormal load transfer that may lead to development of pain, loss of motion and degenerative change. The formula for successful treatment for these injuries is elusive, however, and spans a wide array of options from simple casting to complex operative reduction.

Surgical intervention is driven by the assumption that a more favorable clinical result will be achieved by obtaining an anatomic congruous reduction of the articular surface, yet surgery is not without serious potential complications.

There is a paucity of clinical literature to support the hypothesis that anatomic reduction of the articular surface will predictably lead to improved clinical outcomes. Several clinical studies demonstrate little to no association between articular surface step off and patient satisfaction, pain or function. The relative contributions of the articular cartilage inspection sustained at the moment of impact to the function and longevity of articular chondrocytes is unknown.

Dr. Wolfe has developed an animal model to simulate a human intraarticular distal radius fracture and to study the combined effect of residual articular incongruity and articular surface impaction on the fate of the articular cartilage.

He hypothesizes that impaction of the articular surface will potentiate the development of degenerative arthritis in an incongruent articular surface following fracture and rigid internal fixation.

The findings of this study will lay the foundation for future investigations to elucidate the articular chondrocyte response to articular impaction injuries, the threshold of articular congruency necessary for development degenerative change and the temporal relationship of degenerative arthritis to articular impaction. Testing of possible treatments to slow or reverse the adverse effects of abnormal mechanical load or joint impaction injury will be the focus of future studies.

Co-Investigators

David Jaskwhich, M.D., Richard Gilbert, M.D., Joseph F. Slade, III, M.D., Manohar M. Panjabi, Ph.D.

References

  • Wolfe, SW, Swigart CR, Grauer J, Slade J, Panjabi MM: Augmented External Fixation of Distal Radius Fractures: A Biomechanical Analysis. Journal of Hand Surgery, 23A (1): 127-134, 1998.
  • Wolfe, SW, Lorenze M, Austin G, Swigart CR, Panjabi MM: Load-Displacement Behavior in the Distal Radius Fracture Model. Effects of Simulated Partial Healing. Journal of Bone and Joint Surgery. 81A: 53-59, 1999.
  • Criso JJ, McGovern RD, Wolfe SW: A Noninvasive Technique for Measuring In Vivo Three-Dimensional Carpal Bone Kinematics. Journal Orthopaedic Research, 17 (1): 96-100, 1999.
  • Wolfe SW, Austin G, Lorenze M, Grauer J, Panjabi MM: Comparative Stability of External Fixation: A Biomechanical Study. Journal of Hand Surgery. 24A: 516-524, 1999.
  • Wolfe SW, Pike L, Slade J, Katz LD: Augmentation of Distal Radius Fracture with Fixation with Coraline hydroxyapatite Bone Graft Substitute. Journal of Hand Surgery. 24A (4): 816-827, 1999.