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Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono- and polytrauma: intramedullary nailing vs. external fixation of femoral fractures.
- Source :
-
European journal of medical research [Eur J Med Res] 2020 Nov 26; Vol. 25 (1), pp. 62. Date of Electronic Publication: 2020 Nov 26. - Publication Year :
- 2020
-
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.<br />Material and Methods: A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemorrhagic 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.<br />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.<br />Conclusion: The reduction of PMNL invasion into the nearby muscle tissue of a monotrauma femur fracture stabilized 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 generalized immune reaction.
- Subjects :
- Animals
Bone Nails
Cytokines genetics
External Fixators
Femoral Fractures genetics
Fracture Fixation instrumentation
Fracture Fixation, Intramedullary instrumentation
Fracture Fixation, Intramedullary methods
Fracture Healing genetics
Gene Expression
Humans
Multiple Trauma genetics
Muscles metabolism
Swine
Disease Models, Animal
Femoral Fractures surgery
Fracture Fixation methods
Granulocytes pathology
Multiple Trauma surgery
Muscles pathology
Subjects
Details
- Language :
- English
- ISSN :
- 2047-783X
- Volume :
- 25
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- European journal of medical research
- Publication Type :
- Academic Journal
- Accession number :
- 33243279
- Full Text :
- https://doi.org/10.1186/s40001-020-00461-y