Changes in serum levels of receptor activator of nuclear factor-kappaB ligand, osteoprotegerin, IL-6 and TNF-alpha in patients with a concomitant head injury and fracture.
BACKGROUND
Several reports indicated that interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF- alpha) play important regulatory roles in bone remodeling and homeostasis. In addition, receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) have been shown to be important regulators of osteoclastogenesis during bone remodeling, and their expressions were examined during fracture healing in a mouse model of tibial fracture. However, studies linking RANKL, OPG, IL-6 and TNF-alpha in patients with head injury and fracture are lacking.


METHODS
Within the first few hours of admission to hospital and at 4, 8, and 12 weeks after the injury, we evaluated changes in serum levels of RANKL, OPG, IL-6 and TNF-alpha in 24 male patients with a concomitant head injury and fracture and in 26 male patients with fracture only. These levels were compared with those found in 36 healthy controls.


RESULTS
The RANKL/OPG ratios were found to significantly lower in patients with a concomitant head injury and fracture than in the controls immediately after admission and at 4, 8, and 12 weeks after the injury. In addition, RANKL/OPG ratios were significantly lower in patients with a concomitant head injury and fracture than in those with fracture at 8 and 12 weeks after the injury. The serum IL-6 levels were significantly higher in patients with a concomitant head injury and fracture than in the controls upon admission, and at 4, 8, and 12 weeks after the injury. Moreover, the serum IL-6 levels were significantly higher in patients with a head injury and fracture than in those with just a fracture at 4, 8, and 12 weeks after the injury.


CONCLUSIONS
Based on these changes in the profiles of RANKL, OPG, and IL-6 and the RANKL/OPG ratio, altered repair of a fracture can occur in patients with a concomitant head injury and fracture.
Lee
Jung Sub
JS
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Pusan, South Korea.
Ryu
Chang Hoon
CH
Moon
Nam Hoon
NH
Kim
Seong-Jang
SJ
Park
Shin Young
SY
Suh
Kuen Tak
KT
D000328:Adult; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000097:blood / Q000453:epidemiology*; D005264:Femoral Fractures / Q000097:blood / Q000453:epidemiology; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000097:blood / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000097:blood / Q000453:epidemiology; D015850:Interleukin-6 / Q000097:blood*; D020198:Intracranial Hemorrhage, Traumatic / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000097:blood*; D053245:RANK Ligand / Q000097:blood*; D013978:Tibial Fractures / Q000097:blood / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
D015850:Interleukin-6; D053244:Osteoprotegerin; D053245:RANK Ligand; D014409:Tumor Necrosis Factor-alpha