A concomitant bone fracture delays cognitive recovery from traumatic brain injury

Abstract

A long BF accompanying TBI worsens early neurologic recovery and subsequent learning/memory. Enoxaparin may partially counter this and improve neurologic recovery.

Early Reciprocal Effects in a Murine Model of Traumatic Brain Injury and Femoral Fracture

“…Combined injuries showed the strongest neuromotor impairment over time and failure of neuromotor recovery compared to isolated TBI or FF. The negative effects of FF on neuromotor performance in the present study are in agreement with previous findings in animals with combined brain and leg bone injury [ 20 , 21 , 38 ]. It should be noted that the majority of tasks designed to evaluate neurological deficits, including those applied in the present study, involve locomotion and therefore limb fracture can represent a confounding factor.…”

“…However, it is possible that inflammatory peaks in polytrauma mice may have preceded our observation time point at 5 dpi. Nevertheless, immunostainings at perilesional sites and corresponding contralateral sites revealed an increased ratio of reactive astrocytes in polytrauma compared to isolated TBI, which is in agreement with previous studies [ 20 , 38 ]. A trend towards increased ipsi- to contralateral hemispheric ratio was also observed in the uninjured brains of animals with isolated femoral fracture compared to sham.…”

“…However, in the perilesional GCL of the hippocampus, an increased substance loss was found in polytrauma mice. Histopathological aggravations after TBI, when accompanied by an osseous trauma, have been demonstrated in previous studies [ 20 , 21 , 38 , 42 ]. Two of these studies demonstrated increased mRNA expression and brain tissue concentration of the proinflammatory cytokine IL-1 β at early (24 h and 4 d) and late (35 d) posttraumatic time points, respectively [ 20 , 21 ].…”

Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment

“…Both TSCI and TBI are further reported to reduce bone quality, potentially as a result of afferent signalling from brain and spinal cord to bone and muscle [ 63 , 64 , 65 , 66 ]. Opposite to the afferent interaction, concomitant fractures were reported to negatively affect cerebral oedema formation and delay cognitive recovery following TBI [ 67 , 68 ]. Therefore, efferent effects of bone and muscle on the brain and their therapeutic potential represent a contemporary issue [ 69 , 70 ].…”

“…In contrast to the negative effect on bone quality, TSCI and TBI were both identified to cause heterotopic ossifications (HO) [ 65 ] and improved healing of concomitant long-bone fractures in humans [ 71 , 72 ]. Therefore, experimental models have been developed in order to investigate the underlying mechanisms [ 64 , 68 , 73 , 74 , 75 ]. Clinical observations of spinal cord injury report different risk factors for HO, including complete injuries, spasticity and pneumonia [ 76 ].…”