The Synovial Fingerprint of Ankle Fractures: A Central Role for WNT Pathway Activation in Posttraumatic Ankle Osteoarthritis

These findings support the hypothesis that ankle OA following fracture represents a molecularly distinct subtype. Although WNT pathway activation has been known in OA, its broader activation in PTOA suggests that joint trauma initiates a pathologic synovial cascade, with WNT pathway activation playing a central role. The clear timing of most ankle fractures offers a unique opportunity for early therapeutic intervention. Focused research on the synovial molecular link between ankle fractures and PTOA could underpin the development of targeted, disease-modifying strategies in the immediate postinjury period.