title: Impaired Fracture Healing after Hemorrhagic Shock.
abstract: Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP) of 35 mmHg for 90 minutes). Serum cytokines (IL-6, KC, MCP-1, and TNF-α) were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.
authors.affiliation: Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Philipp
authors.identifier: 0000-0002-5033-9964
authors.initials: P
authors.lastname: Lichte
authors.affiliation: Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
authors.affiliation: Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein, Campus Kiel, Am Botanischen Garten 14, 24118 Kiel, Germany.
authors.forename: Graeme C
authors.initials: GC
authors.lastname: Campbell
authors.affiliation: Institute of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
authors.forename: Rainer
authors.identifier: 0000-0002-6124-3466
authors.initials: R
authors.lastname: Beckmann
authors.affiliation: Institute of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
authors.forename: Mersedeh
authors.initials: M
authors.lastname: Tohidnezhad
authors.affiliation: Department of Dental Materials and Biomaterials Research, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bergmann
authors.affiliation: Institute of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
authors.forename: Mamed
authors.initials: M
authors.lastname: Kadyrov
authors.affiliation: Department of Dental Materials and Biomaterials Research, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Fischer
authors.affiliation: Department of Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein, Campus Kiel, Am Botanischen Garten 14, 24118 Kiel, Germany.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Glüer
authors.affiliation: Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Frank
authors.identifier: 0000-0001-7729-9838
authors.initials: F
authors.lastname: Hildebrand
authors.affiliation: Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.affiliation: Institute of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pufe
mesh_terms: D000818:Animals; D016207:Cytokines / Q000097:blood; D017102:Fracture Healing; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D010010:Osteoclasts / Q000502:physiology; D012771:Shock, Hemorrhagic / Q000503:physiopathology*; D055114:X-Ray Microtomography
chemical_list: D016207:Cytokines