title: Comparison of fibrinogen- and collagen-based treatments for penetrating wounds with comminuted femur fractures in a Swine model.
abstract: BACKGROUND
  Military servicemembers in combat operations often sustain injuries to the extremities from highspeed projectiles, resulting in bleeding and comminuted open fractures. Severe injury with bone fragmentation can result in limb amputation. Surgical treatment options include materials that promote osteogenesis and bone proliferation, such as growth hormones, stem cells, or mineralized matrix adjuncts. However, none of these are amenable to use by the first responder, nor do they address the question of hemorrhage control, which is a common problem in traumatic injuries.
  
  
  OBJECTIVE
  Our hypothesis was that treatment with a fibrinogen-based protein mixture at the time of the bone injury will provide both hemostasis and a supportive environment for preservation of injured bone.
  
  
  METHODS
  A comminuted femur fracture was produced in 28 female Yorkshire swine, and one of four treatments was instilled into the wound immediately after injury. Each animal was evaluated for the following parameters: inflammation, new bone growth, osteoclast proliferation, callus formation, and femur wound cavity fill, using post-mortem computed tomography and analysis of histological sections.
  
  
  RESULTS
  Overall, salmon fibrinogen?thrombin and porcine fibrinogen?thrombin showed a trend for improved healing based on bone filling and calcification. However, statistically significant differences could not be established between treatment groups.
  
  
  CONCLUSIONS
  These findings indicate that a fibrinogen?thrombin matrix may be a useful as an immediate response product to enhance fracture healing. Salmon fibrinogen?thrombin has the advantages of cost and a pathogen profile compared to mammalian fibrinogens.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Rothwell
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sawyer
authors.forename: Eric
authors.initials: E
authors.lastname: Lombardini
authors.forename: Joseph
authors.initials: J
authors.lastname: Royal
authors.forename: Haiyin
authors.initials: H
authors.lastname: Tang
authors.forename: Reed
authors.initials: R
authors.lastname: Selwyn
authors.forename: Michael
authors.initials: M
authors.lastname: Bodo
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Settle
mesh_terms: D000818:Animals; D003094:Collagen; D005340:Fibrinogen; D018460:Fractures, Comminuted; D006490:Hemostatics; D013552:Swine; D014950:Wounds, Penetrating
chemical_list: D006490:Hemostatics; D005340:Fibrinogen; D003094:Collagen