An intra-articular fracture is a bone fracture that goes all the way into a joint instead of stopping short of the joint, which is called an extra-articular fracture. The wrist is particularly prone to intra-articular fractures, although they can occur at other joints as well. They can be complex and challenging to treat, and the patient might need surgery and physical therapy to recover. Patients might want to consider seeing a hand specialist in the case of a wrist fracture, because problems with healing can create lifelong issues such as a lack of flexibility in the wrist.
In an intra-articular fracture, in addition to breaking the bone, the patient also rips and tears cartilage. Swelling typically sets in almost immediately, and the patient might notice extreme pain. An X-ray evaluation of the injury site should show the fracture and its extent, illustrating that the break has moved into the structure of the joint. An orthopedic specialist can determine the best course of treatment.
Ideally, an intra-articular fracture should be set in a way that allows the patient to continue moving the joint during the healing process. This can increase flexibility in the joint and prevent atrophy, a common problem with immobilized fractures. The fracture might contain bone fragments, and in the process of setting it, the doctor needs to be careful to connect them all and eliminate any drifting or protruding components.
A simple cast might not be enough. More commonly, the patient needs surgery. During surgery, the doctor can clean out the site, carefully reattach the bones with pins and install an external fixator. This device holds the fracture in place during healing while still allowing some range of motion. It usually is more comfortable than a cast, although the patient does need to take some special steps to take care of it. An external fixator can expose the patient to the risk of infections because it creates an opening in the skin.
If an intra-articular fracture heals poorly, the shape and structure of the joint can change. The patient might develop a protuberance at the site and could have a more limited range of motion than before the injury. There also is a risk that the patient's joint might be weakened and could develop arthritis later in life. Broken limbs in general can predispose patients to arthritis, and it can be almost inevitable with an intra-articular fracture. Measures such as using physical therapy to build up strength and agility, eating a balanced diet and being alert to signs of inflammation are very important during recovery from an intra-articular fracture.