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Pseudofracture: An Acute Peripheral Tissue Trauma Model
Published on: April 18, 2011
Systemic inflammatory response after extremity or truncal fracture operations.
Hans-Christoph Pape1, Martijn V Griensven, Frank F Hildebrand
1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. papehc@aol.com
The Journal of Trauma
|December 17, 2008
Summary
Proinflammatory cytokine release, including interleukin-6 (IL-6) and IL-8, is elevated after pelvic fracture surgery and correlates with blood loss. These immunologic markers indicate subclinical changes related to surgical magnitude, not duration.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Immunology
Background:
- Blunt trauma patients exhibit varying levels of proinflammatory markers.
- The relationship between these markers, blood loss, and surgery duration in different fracture locations requires assessment.
Purpose of the Study:
- To evaluate proinflammatory markers (IL-6 and IL-8) in blunt trauma patients.
- To determine the correlation of these markers with blood loss and surgical duration across different fracture types.
Main Methods:
- A prospective, multicenter, nonrandomized cohort study involving 68 blunt trauma patients with truncal or extremity fractures.
- Patients with spinal fractures (SF), pelvic and acetabular fractures (PAF), or isolated fractures (FF) underwent surgical fixation.
- Perioperative concentrations of IL-6 and IL-8 were measured in central venous blood and correlated with blood loss and surgery duration.
Main Results:
- Pelvic and acetabular fracture fixation (PAF) showed a significant perioperative increase in IL-6, comparable to isolated femoral fractures (FF).
- Spinal fracture fixation (SF) resulted in considerably lower IL-6 increases.
- In the PAF group, IL-6 and IL-8 changes correlated positively with blood loss, but not with surgery duration.
Conclusions:
- Pelvic fracture surgery elicits a higher release of proinflammatory cytokines compared to spine fracture fixation, linked to blood loss.
- Increased cytokine levels were observed early post-surgery (days 1-2) across all groups.
- The magnitude of surgery, rather than its duration, appears to influence the level of released immunologic markers.
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