Systemic inflammation induced by a thoracic trauma alters the cellular composition of the early fracture callus.
BACKGROUND
We recently demonstrated that a blunt chest trauma, a strong inducer of the posttraumatic systemic inflammatory response and one of the most critical injuries in polytrauma patients, significantly delayed fracture healing in rats, possibly by the interaction of the systemic inflammation with early regeneration processes locally at the fracture site. The underlying cellular mechanisms, however, have as yet remained unknown. Therefore, the aim of this study was to analyze the cellular and morphologic composition of the early fracture callus after a blunt chest trauma.


METHODS
Rats received an osteotomy of the right femur stabilized by an external fixator in combination with a blunt chest trauma or not. The animals were killed after 3, 7, and 35 days, and the fracture calli were analyzed histologically for new tissue formation, polymorphonuclear leucocytes, macrophages, osteoclasts, and the presence of the proinflammatory cytokine interleukin 6.


RESULTS
The blunt chest trauma considerably increased the number of polymorphonuclear leucocytes in the callus by Day 3 compared with animals with isolated fractures. The number of macrophages was significantly reduced by the thoracic trauma at Days 3 and 7. The number of osteoclasts was not changed at any postoperative time point. After 3 days, the blunt chest trauma led to a significantly stronger interleukin 6 staining within the periosteal callus in zones of intramembranous ossification. During the time of cortical bridging at Day 35, the amount of newly formed bone was significantly decreased after blunt chest trauma.


CONCLUSIONS
Our results suggest that the systemic posttraumatic inflammation induced by a thoracic trauma disturbed the inflammatory balance during the early healing stage by altering the recruitment of inflammatory cells and cytokine expression locally at the fracture site and thus impaired fracture healing. These findings provide new insights in the pathomechanisms of impaired fracture healing in patients experiencing severe trauma.
Institute of Orthopaedic Research and Biomechanics, Center of Surgery, University of Ulm, Ulm, Germany.
Stefan
S
Recknagel
Ronny
R
Bindl
Christoph
C
Brochhausen
Melanie
M
Göckelmann
Tim
T
Wehner
Philipp
P
Schoengraf
Markus
M
Huber-Lang
Lutz
L
Claes
Anita
A
Ignatius
D000818:Animals; D002146:Bony Callus / Q000737:chemistry / Q000166:cytology / Q000473:pathology / Q000503:physiopathology*; D004195:Disease Models, Animal; D005264:Femoral Fractures / Q000503:physiopathology*; D015850:Interleukin-6 / Q000032:analysis / Q000502:physiology; D008264:Macrophages / Q000502:physiology; D008297:Male; D009104:Multiple Trauma / Q000503:physiopathology; D009504:Neutrophils / Q000502:physiology; D010010:Osteoclasts / Q000502:physiology; D051381:Rats; D017208:Rats, Wistar; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000503:physiopathology; D013898:Thoracic Injuries / Q000150:complications*; D013997:Time Factors
D015850:Interleukin-6