Acute Percutaneous Saline Lavage of Intra-articular Ankle Fractures Leads to Significant Decrease in Interleukin-1β Synovial Fluid Concentration: A Randomized Controlled Trial

Background: Post-traumatic osteoarthritis (PTOA) is a frequent, debilitating outcome following intra-articular ankle fracture. Pro-inflammatory mediators present in the synovial fluid fracture hematoma following intra-articular fracture have been linked to cartilage damage, which may contribute to the development of PTOA. The purpose of this study was to perform a prospective, randomized controlled trial to determine the effect of percutaneous, saline lavage performed within 24 hours of injury, on the composition of the intra-articular microenvironment at the time of definitive surgical fixation. Methods: Forty-one adult patients with 41 intra-articular ankle fractures presenting to the ED within 24 hours of injury were consented and randomized prior to aspiration to undergo percutaneous saline lavage (group 1) or no lavage (group 2); all patients then underwent aspiration of their injured ankle, then percutaneous lavage if in group 1, followed by routine fracture reduction and splinting. Repeat aspiration of the injured ankle was performed when patients returned for definitive surgery. Nine patients did not complete the study because of inadequate aspirate volume, definitive fixation at an outside hospital, or loss to follow-up, leaving 32 patients (group 1, n = 17; group 2, n = 15) for final analysis. All aspirates were analyzed for the presence of cytokines (interleukin [IL]-1β, IL-6) and type 2 cartilage breakdown product (CTXII). Final analyte values at the time of surgery as well as the change (Δ) in analyte concentrations between aspirates were compared between groups to determine the effect of lavage. Results: There was a statistically significant difference in the change in IL-1B concentration between groups 1 and 2 (Δ −11.05 ± 7.07 vs −5.30 ± 8.31 pg/mL; P = .043). There were no other statistically significant differences between groups 1 and 2 with respect to the final concentrations or Δ values of IL-6 (final P = .706; Δ P = .415). With the numbers available, no significant difference could be detected for CTXII (final P = .925; Δ P = .428). Conclusion: Percutaneous saline lavage of intra-articular ankle fractures performed within 24 hours of injury leads to a statistically significant decrease in IL-1β concentration within synovial fluid aspirates at the time of definitive surgical fixation. There was no significant difference in IL-6 concentration between lavage and control subjects, and with the numbers available, no significant difference could be detected for cartilage breakdown products Level of Evidence: Level II, prospective randomized pilot trial.