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Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture.

Questions/purposes

We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both.

Methods

Male C57/BL6 mice (8–10 weeks old, 20–30 g) were assigned to four groups: bone fragment injection (BF, n = 9) group; soft tissue injury (STI, n = 9) group; BF + STI (n = 9) group, in which both insults were applied; and control group, in which neither insult was applied. Animals were sacrificed at 6 hours. As surrogates for systemic inflammation, we measured serum IL-6, IL-10, osteopontin, and alanine aminotransferase (ALT) and nuclear factor (NF)-κB and myeloperoxidase (MPO) in the lung.

Results

The systemic inflammatory response (mean IL-6 level) was similar in the BF (61.8 pg/mL) and STI (67.9 pg/mL) groups. The combination (BF + STI) of both traumatic insults induced an increase in mean levels of inflammatory parameters (IL-6: 189.1 pg/mL) but not in MPO levels (1.21 ng/mL) as compared with the BF (0.82 ng/mL) and STI (1.26 ng/mL) groups. The model produced little evidence of remote organ inflammation.

Conclusions

Our findings suggest both bone and soft tissue injury are required to induce systemic changes. The absence of remote organ inflammation suggests further fracture-associated factors, such as hemorrhage and fat liberation, may be more critical for induction of remote organ damage.

Clinical Relevance

Both bone and soft tissue injuries contribute to the systemic inflammatory response.

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Acknowledgments

We thank John Brumfield, Roop Gill MD, Derek Barclay MD, and the laboratory of the Department of Surgery, University of Pittsburgh Medical Center, for technical assistance.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Aachen Medical Center, Pauwelsstr 30, 52074, Aachen, Germany

    Roman Pfeifer MD & Hans-Christoph Pape MD, FACS

  2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Roman Pfeifer MD, Sophie Darwiche MD, Lauryn Kohut MA & Timothy R. Billiar MD, FACS

Authors
  1. Roman Pfeifer MD
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  2. Sophie Darwiche MD
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  3. Lauryn Kohut MA
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  4. Timothy R. Billiar MD, FACS
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  5. Hans-Christoph Pape MD, FACS
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Corresponding author

Correspondence to Roman Pfeifer MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA

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Pfeifer, R., Darwiche, S., Kohut, L. et al. Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study. Clin Orthop Relat Res 471, 2815–2821 (2013). https://doi.org/10.1007/s11999-013-2908-8

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  • DOI: https://doi.org/10.1007/s11999-013-2908-8

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