[TGF-beta1 as a pathophysiological factor in fracture healing].
OBJECTIVE
TGF-beta1 is an important local and systemic regulatory molecule during fracture healing. Various authors have shown differences in the systemic levels of TGF-beta1 over the time taken for bone healing in distraction osteogenesis and osteotomies. Previous studies have shown characteristic differences in the physiological levels of growth factors between normal fracture healing and delayed fracture union. The aim of the present study was to evaluate possible differences in sera levels of patients with normal and delayed union fracture healing.


METHODS
Patients with long bone shaft fractures were recruited prospectively. Peripheral blood samples were collected over a period of 1 year using a standardized time schedule. At the end of the individual's investigation period, TGF-beta1 levels were determined. To achieve a homogeneous collective of patients, only those with a maximum of two fractures were included in the study. After matching for four criteria, we compared patients with normal fracture healing to patients with delayed unions. The fact of delayed union was accepted in case of failed consolidation 4 months after trauma.


RESULTS
During a prospective study period of 1 year, 15 patients with normal fracture healing could be compared to 15 patients suffering from delayed union. By determining the absolute sera levels we found a typical increase of TGF-beta1 up to 2 weeks after fracture in both groups, with a subsequent decrease up to the sixth week after fracture. However, a decline in serum concentration occurred earlier in patients with delayed union, causing significantly lower TGF-beta1 levels in the non-union group 4 weeks after trauma (P=0.00006).


CONCLUSIONS
Even with a relatively small number of patients, we could show a significant difference in serum concentrations of TGF-beta1 between the investigated groups. If these results can be verified within a larger collective, TGF-beta1 could be used as a predictive cytokine for delayed fracture healing.
Zimmermann
G
G
Unfallchirurgische Klinik der Berufsgenossenschaftlichen Unfallklinik, Universität Heidelberg, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Deutschland. Zimmermann@BGU-Ludwigshafen.de
Moghaddam
A
A
Reumann
M
M
Wangler
B
B
Breier
L
L
Wentzensen
A
A
Henle
P
P
Weiss
S
S
D000328:Adult; D000368:Aged; D001860:Bone Plates; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000503:physiopathology* / Q000601:surgery; D005599:Fractures, Ununited / Q000503:physiopathology*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000503:physiopathology*; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery; D012016:Reference Values; D013223:Statistics as Topic; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery; D053773:Transforming Growth Factor beta1 / Q000097:blood*
D053773:Transforming Growth Factor beta1