title: Reaming in treatment of non-unions in long bones: cytokine expression course as a tool for evaluation of non-union therapy.
abstract: The analysis of peripheral serum cytokine expression patterns has been shown to be a possible method for demonstrating changes in bone metabolism. The aim of this study is to evaluate the effectiveness of this method within the treatment of long bone non-union with intramedullary reaming, a well-established non-union treatment concept.
  
  
  METHODS
  Three groups were added to this study: group one (G1) suffered from long bone non-unions, treated successfully with intramedullary reaming; group two (G2) consisted of long bone fractures with proper fracture healing; and group three (G3) included long bone fractures resulting in non-unions. We took blood samples on day 2, and after week 1, 4, 6, month 3 and 6 after initial treatment. Clinical and radiological follow-up were provided for 6 months. We measured transforming growth factor ß-1 (TGFß-1), platelet-derived growth factor (PDGF-AB), and insulin like growth factor-1 (IGF-1) at all-time points.
  
  
  RESULTS
  TGF-ß1 levels in G1 and G2 increased from day 2 to 6 weeks after surgery. In general, G1 and G2 showed parallel TGF-ß1 expression patterns, and G3 had a significant peak during first week compared to G1 (p = 0.023). PDGF peaked in G3 during first week after treatment, whereas G1 had its maximum after 4 weeks and G2 after 6 weeks. We were able to detect a significantly lower PDGF concentration at 3 months in G1 compared to G3 (p = 0.029). IGF-1 showed a peak concentration in G1 during the first 4 weeks. Afterwards, concentration levels in both G1 and G2 were higher.
  
  
  CONCLUSIONS
  Our study was able to show that the cytokine expression pattern in physiological bone healing is similar to that in successful non-union treatment with intramedullary reaming. Our results show that the effect of non-union therapy could be observed objectively by measuring cytokine expression patterns in peripheral blood even in a small group of patients.
authors.affiliation: Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Westhauser
authors.forename: Gerald
authors.initials: G
authors.lastname: Zimmermann
authors.forename: Sanaz
authors.initials: S
authors.lastname: Moghaddam
authors.forename: Tom
authors.initials: T
authors.lastname: Bruckner
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schmidmaier
authors.forename: Bahram
authors.initials: B
authors.lastname: Biglari
authors.forename: Arash
authors.initials: A
authors.lastname: Moghaddam
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013978:Tibial Fractures / Q000601:surgery
chemical_list: D016207:Cytokines