Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono- and poly
- PDF / 1,560,779 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 8 Downloads / 149 Views
European Journal of Medical Research Open Access
RESEARCH
Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono‑ and polytrauma: intramedullary nailing vs. external fixation of femoral fractures Johannes Greven1* , Klemens Horst1, Zhi Qiao2, Felix Marius Bläsius1, Ümit Mert1, Michel Paul Johan Teuben3, Nils Hendrik Becker1, Roman Pfeifer3, Hans‑Christoph Pape3 and Frank Hildebrand1
Abstract Background: In the stabilization of femoral fractures in mono- and polytrauma, clinical practice has shown better care through intramedullary nailing. However, the reason why this is the case is not fully understood. In addition to concomitant injuries, the immunological aspect is increasingly coming to the fore. Neutrophil granulocytes (PMNL), in particular next to other immunological cell types, seem to be associated with the fracture healing processes. For this reason, the early phase after fracture (up to 72 h after trauma) near the fracture zone in muscle tissue was investigated in a pig model. Material and methods: A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemor‑ rhagic shock, liver laceration, and femur fracture) was used to demonstrate the immunological situation through muscle biopsies and their analysis by histology and qRT-PCR during a 72 h follow-up phase. Two stabilization methods were used (intramedullary nail vs. external fixator) and compared with a nontraumatized sham group. Results: Monotrauma shows higher PMNL numbers in muscle tissue compared with polytrauma (15.52 ± 5.39 mono vs. 8.23 ± 3.36 poly; p = 0.013), regardless of the treatment strategy. In contrast, polytrauma shows a longer lasting invasion of PMNL (24 h vs. 72 h). At 24 h in the case of monotrauma, the fracture treated with external fixation shows more PMNL than the fracture treated with intramedullary nailing (p = 0.026). This difference cannot be determined in polytrauma probably caused by a generalized immune response. Both monotrauma and polytrauma show a delayed PMNL increase in the muscle tissue of the uninjured side. The use of intramedullary nailing in monotrauma resulted in a significant increase in IL-6 (2 h after trauma) and IL-8 (24 and 48 h after trauma) transcription. Conclusion: The reduction of PMNL invasion into the nearby muscle tissue of a monotrauma femur fracture stabi‑ lized by intramedullary nailing supports the advantages found in everyday clinical practice and therefore underlines the usage of nailing. For the polytrauma situation, the fixation seems to play a minor role, possibly due to a general‑ ized immune reaction.
*Correspondence: [email protected] 1 Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelstraße 30, 52074 Aachen, Germany Full list of author information is available at the end of the article © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduct
Data Loading...
