Clinical Orthopaedics and Related Research®

, Volume 469, Issue 11, pp 3118–3126

Human Early Fracture Hematoma Is Characterized by Inflammation and Hypoxia

Authors

    • Department of Rheumatology and Clinical ImmunologyCharité University Hospital
    • German Arthritis Research Center
  • Timo Gaber
    • Department of Rheumatology and Clinical ImmunologyCharité University Hospital
    • German Arthritis Research Center
    • Berlin-Brandenburg Center for Regenerative Therapies
  • Carsten Perka
    • Berlin-Brandenburg Center for Regenerative Therapies
    • Julius Wolff InstitutCharité University Hospital
    • Department of OrthopaedicsCharité University Hospital
  • Georg N. Duda
    • Berlin-Brandenburg Center for Regenerative Therapies
    • Julius Wolff InstitutCharité University Hospital
    • Department of OrthopaedicsCharité University Hospital
  • Frank Buttgereit
    • Department of Rheumatology and Clinical ImmunologyCharité University Hospital
    • German Arthritis Research Center
    • Berlin-Brandenburg Center for Regenerative Therapies
Symposium: Bone Repair and Regeneration

DOI: 10.1007/s11999-011-1865-3

Cite this article as:
Kolar, P., Gaber, T., Perka, C. et al. Clin Orthop Relat Res (2011) 469: 3118. doi:10.1007/s11999-011-1865-3

Abstract

Background

An effective immune system, especially during the inflammatory phase, putatively influences the quality and likelihood of bone healing. If and how this is reflected within the initial fracture hematoma is unclear.

Questions/purposes

We therefore asked the following questions: (1) Does the local expression in fracture hematoma of genes involved in adaptation to hypoxia, migration, angiogenesis, and osteogenesis vary as compared to the peripheral blood? (2) Do these changes occur time dependently? (3) Is the gene expression during fracture hematoma formation altered by irradiation?

Methods

Cells from fracture hematoma of 20 patients and hematomas formed in 40 patients after THA (20 without and 20 with preoperative radiation) were isolated and RNA was extracted to analyze the influence of oxygen deprivation during fracture healing on mRNA expression of genes (HIF1A, LDHA, and PGK1) involved in immunoregulation (IL6, IL8, CXCR4), angiogenesis (VEGF, IL8), and osteogenesis (SPP1, RUNX2) by quantitative PCR.

Results

We observed locally increased LDHA gene expression in fracture hematoma cells (6–72 h post fracture) reflecting the adaptation to hypoxia. IL6, IL8, and VEGF upregulation indicated hypoxia-mediated inflammation and angiogenesis; increased CXCR4 expression reflected immigration of immune cells. Osteogenic differentiation was reflected in the increased expression of the SPP1 and RUNX2 genes. The increased expression of the LDHA, VEGF, IL8, SPP1 and RUNX2 genes occurred time dependently. Irradiation suppressed HIF1A, IL6, IL8, CXCR4, and RUNX2 gene expression.

Conclusions

Our data suggest cells in the fracture hematoma (1) adapt to hypoxia and (2) promote inflammation in fracture healing at the mRNA level, indicating early involvement of the immune system.

Clinical Relevance

The initial fracture hematoma is important for the onset of angiogenesis, chemotaxis, and osteogenesis.

Copyright information

© The Association of Bone and Joint Surgeons® 2011