Bone Healing and Hormonal Bioassay in Patients with Long-Bone Fractures and Concomitant Head Injury

Abstract

Objective: The aim of this study is to investigate healing of fractures in patients with concomitant head injuries and to measure blood hormone levels to elucidate the mechanism of a possible accelerated osteogenesis. Materials and Methods: One hundred and sixty-two patients were included in this study and divided into 3 cohorts: group A with head injuries only (n = 52); group B with head injuries as well as long-bone fractures (n = 50); group C with long-bone fractures only (n = 60). Fracture-healing parameters including time of appearance and thickness of the bridging callus, and blood hormonal assays were measured and compared using Student's t test. Results: The mean time to healing was significantly lower in cohort B (6.9 ± 2.9 weeks) than C (22.4 ± 8.7 weeks; p = 0.001). The mean thickness of the healing callus was significantly higher in cohort B (26.3 ± 9.7 mm) than C (8.1 ± 5.9 mm; p = 0.002). The mean healing rate was also higher in cohort B (4.5 ± 2.3 mm/week) than C (0.38 ± 0.21 mm/week; p = 0.001). Blood hormonal assays in group B showed higher values of parathyroid hormone and growth hormone than in group C. However, adrenaline and noradrenaline values were lower in group B than in group C at all measured time intervals, and correspondingly leptin was lower in all groups (p = 0.001). Corticosteroid values were normal in group B compared to slightly higher values in group C, also at all measured time intervals. Conclusion: In this study, healing of fractures in patients with concomitant head injuries was accelerated, thereby indicating an involvement of a combined neurohormonal mechanism.

Is Healing of Fractures Regulated Centrally?

“…The study also, showed statistically significant higher levels of growth factors of PDGF, VEGF, Activin-A, and cytokine I-L-1, along the 3 weeks of follow-up (P>0.005). I-IGF-II showed statistically significant subnormal level along the whole followup period in the same patients (P>0.005) [1,2].…”

“…These sera were used as well, to investigate their effect on the growth of stem cell culture by measuring the cell count of cell line of human bone marrow-derived mesenchymal stem cells MSCs (ATCC-USA) treated with control and patients' sera from different groups after 72 hrs incubation [1,2].…”

Can fracture healing be accelerated by serum transfer in head trauma cases? An experimental head trauma model in rats

“…The mechanisms affecting fracture union after head trauma are still not fully understood. In a recent study, [16] it was claimed that the combination of relative inhibition of the sympathetic nervous system and non-hormonal mechanisms was effective. In the same study, parathyroid hormone levels peaked in the first 24 h in human serum samples from cases with head trauma and from cases who had head trauma accompanied by long bone fractures, and that both groups had higher values than the control group with isolated long bone fractures.…”

Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries

“…This assumption would also support the finding of the aforementioned experimental study that fracture fixation has more impact on fracture healing than concomitant injuries [ 23 ]. Another clinical study demonstrated shorter healing times, greater callus volumes and higher fracture healing rates in patients with concomitant TBI [ 25 ]. In contrast to our study, they included all long bones fractures (including humeral and fibular fractures) treated either with intramedullary nailing or plate osteosynthesis.…”