Influence of haemorrhagic shock on fracture healing

Bumann, Mark; Henke, Thomas; Gerngroß, H.; Augat, Peter

doi:10.1007/s00423-003-0405-3

Cited by 22 publications

(29 citation statements)

References 34 publications

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“…A closed fracture was created by three-point bending of the tibia, applying an impact velocity of 1.6 m/s by dropping a weight of 650 g from a height of 13 cm. 12,13 The fracture level was set about 2 to 3 mm proximal to the junction of tibia and fibula (Fig. 1).…”

Section: Experimental Modelmentioning

confidence: 99%

“…14 Blood flow was measured on anesthetized rats by a laser Doppler flowmetry (Optoflow Lea, Giessen, Germany) described in more detail in a previous publication. 13 Briefly, the blood flow was measured at the level of the fracture where the laser light detects blood flow up to a depth of 1.8 to 2 mm. The data were collected preoperatively, postoperatively, and on days 1, 3, 7, 14, and 28 as a mean value over 20 s of measurement time.…”

Section: Experimental Modelmentioning

confidence: 99%

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Moderate soft tissue trauma delays new bone formation only in the early phase of fracture healing

Claes

Maurer-Klein

Henke

et al. 2006

Journal Orthopaedic Research

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The aim of this study was to investigate the effect of a moderate soft tissue trauma to the course of fracture healing in a standardized animal model. Thirty‐eight Wistar rats were randomly divided into a fracture group (F, n = 19) and a group with a fracture and a soft tissue trauma (F + STT, n = 19). The fracture and the soft tissue trauma were created using an impact device with a standardized energy. All fractures were stabilized by two Kirschner wires. Three rats were measured for blood flow and sacrificed at days 1, 3, 7, and 14, and seven rats at day 28, from both groups. A three‐point bending test was performed on the healed tibia after 28 days. During the first 24 h there was a reduction in blood flow, which was more pronounced in the F + STT group than in the F group. From histological sections, the shape of the callus formation, as well as the tissue distribution of newly formed bone, fibrous cartilage and fibrous connective tissue were determined. Distinctly more periosteal new bone formed and a larger callus formed at days 3 and 7 in group F compared to group F + STT. However, by days 14 and 28, the ossification and overall callus size no longer showed differences between the two groups. A fast recovery of blood flow and callus formation took place in the F + STT group, which led to similar histological and biomechanical results in fracture healing observed after 28 days between the two groups. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:1178–1185, 2006

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Section: Experimental Modelmentioning

confidence: 99%

Section: Experimental Modelmentioning

confidence: 99%

Moderate soft tissue trauma delays new bone formation only in the early phase of fracture healing

Claes

Maurer-Klein

Henke

et al. 2006

Journal Orthopaedic Research

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“…31 Hemorrhagic shock is a common finding in the setting of severe trauma, and the global hypoperfusion adds a very relevant element to a trauma model. [32][33][34][35][36] The pseudofracture model can be easily combined with a hemorrhagic shock model for a multiple trauma model of high severity. 37 Protocol…”

Section: Introductionmentioning

confidence: 99%

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Darwiche

Kobbe²,

Pfeifer³

et al. 2011

JoVE

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Following trauma there is an early hyper-reactive inflammatory response that can lead to multiple organ dysfunction and high mortality in trauma patients; this response is often accompanied by a delayed immunosuppression that adds the clinical complications of infection and can also increase mortality. [1][2][3][4][5][6][7][8][9] Many studies have begun to assess these changes in the reactivity of the immune system following trauma. [10][11][12][13][14][15] Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses. [16][17][18][19][20][21] The challenge in experimental murine trauma modeling is long term investigation, as fracture fixation techniques in mice, can be complex and not easily reproducible. [22][23][24][25][26][27][28][29][30] This pseudofracture model, an easily reproduced trauma model, overcomes these difficulties by immunologically mimicking an extremity fracture environment, while allowing freedom of movement in the animals and long term survival without the continual, prolonged use of anaesthesia. The intent is to recreate the features of long bone fracture; injured muscle and soft tissue are exposed to damaged bone and bone marrow without breaking the native bone.The pseudofracture model consists of two parts: a bilateral muscle crush injury to the hindlimbs, followed by injection of a bone solution into these injured muscles. The bone solution is prepared by harvesting the long bones from both hindlimbs of an age-and weight-matched syngeneic donor. These bones are then crushed and resuspended in phosphate buffered saline to create the bone solution.Bilateral femur fracture is a commonly used and well-established model of extremity trauma, and was the comparative model during the development of the pseudofracture model. Among the variety of available fracture models, we chose to use a closed method of fracture with soft tissue injury as our comparison to the pseudofracture, as we wanted a sterile yet proportionally severe peripheral tissue trauma model. 31 Hemorrhagic shock is a common finding in the setting of severe trauma, and the global hypoperfusion adds a very relevant element to a trauma model. [32][33][34][35][36] The pseudofracture model can be easily combined with a hemorrhagic shock model for a multiple trauma model of high severity. 37 Protocol

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“…5), the temporal and spatial patterns of revascularisation were similar for all animals (statistical analysis, p < 0.05). Large variation in blood perfusion measurements is not uncommon due to the numerous internal and external factors that influence perfusion [5]. Sample size at each time point was small ( n = 5) but comparable to similar studies [50], and larger sample sizes would probably not change the overall trends seen.…”

Section: Discussionmentioning

confidence: 90%

Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

Macdonald

Shefelbine

2013

Med Biol Eng Comput

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Vascularity of the soft tissues around a bone fracture is critical for successful healing, particularly when the vessels in the medullary canal are ruptured. The objective of this work was to use laser Doppler and micro-computer tomography (micro-CT) scanning to characterise neovascularisation of the soft tissues surrounding the fracture during healing. Thirty-two Sprague–Dawley rats underwent mid-shaft osteotomy of the left femur, stabilised with a custom-designed external fixator. Five animals were killed at each of 2, 4 days, 1, 2, 4 and 6 weeks post-operatively. Femoral blood perfusion in the fractured and intact contralateral limbs was measured using laser Doppler scanning pre- and post-operatively and throughout the healing period. At sacrifice, the common iliac artery was cannulated and infused with silicone contrast agent. Micro-CT scans of the femur and adjacent soft tissues revealed vessel characteristics and distribution in relation to the fracture zone. Blood perfusion dropped immediately after surgery and then recovered to greater than the pre-operative level by proliferation of small vessels around the fracture zone. Multi-modal imaging allowed both longitudinal functional and detailed structural analysis of the neovascularisation process.

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Influence of haemorrhagic shock on fracture healing

Cited by 22 publications

References 34 publications

Moderate soft tissue trauma delays new bone formation only in the early phase of fracture healing

Moderate soft tissue trauma delays new bone formation only in the early phase of fracture healing

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

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