The Immediate Intramedullary Nailing Surgery Increased the Mitochondrial DNA Release That Aggravated Systemic Inflammatory Response and Lung Injury Induced by Elderly Hip Fracture

Abstract

Conventional concept suggests that immediate surgery is the optimal choice for elderly hip fracture patients; however, few studies focus on the adverse effect of immediate surgery. This study aims to examine the adverse effect of immediate surgery, as well as to explore the meaning of mtDNA release after trauma. In the experiment, elderly rats, respectively, received hip fracture operations or hip fracture plus intramedullary nail surgery. After fracture operations, the serum mtDNA levels as well as the related indicators of systemic inflammatory response and lung injury significantly increased in the rats. After immediate surgery, the above variables were further increased. The serum mtDNA levels were significantly related with the serum cytokine (TNF-α and IL-10) levels and pulmonary histological score. In order to identify the meaning of mtDNA release following hip fracture, the elderly rats received injections with mtDNA. After treatment, the related indicators of systemic inflammatory response and lung injury significantly increased in the rats. These results demonstrated that the immediate surgery increased the mtDNA release that could aggravate systemic inflammatory response and lung injury induced by elderly hip fracture; serum mtDNA might serve as a potential biomarker of systemic inflammatory response and lung injury following elderly hip fracture.

Early surgery increases mitochondrial DNA release and lung injury in a model of elderly hip fracture and chronic obstructive pulmonary disease

“…Various studies have demonstrated that mtDNA is a critical activator of inflammation and the innate immune system (14,31). Some research reported that cellular injury released mtDNA into blood, which is a key link between trauma, inflammation, soluble immune response suppressor (SIRS) and acute lung injury in polytrauma patients and the elderly hip fracture model (12,13,16). mtDNA contains unmethylated CpG motifs that exhibit immune stimulatory capacities (31).…”

“…A growing body of evidence has suggested that hip fracture induces substantial mitochondrial (mt)DNA release, systemic inflammatory response and lung injury in the elderly (12). Immediate intramedullary nailing surgery could aggravate the above pathological states (12). Similarly, it was previously demonstrated by the current group that hip fracture and surgery also elevate systemic proinflammatory mediators in elderly patients, and the inflammatory response may serve a key role in postoperative lung dysfunction (13).…”

“…Individuals who smoke and have COPD will have a 60-70% higher risk of mortality following proximal femur fracture than those without (11). A growing body of evidence has suggested that hip fracture induces substantial mitochondrial (mt)DNA release, systemic inflammatory response and lung injury in the elderly (12). Immediate intramedullary nailing surgery could aggravate the above pathological states (12).…”

“…Hip fracture and surgery in elderly patients may induce systemic inflammatory responses and lung injury, which increases the risk of pulmonary infection and mortality during the post-injury period (12,13). Therefore, it may be hypothesized that late surgery may be beneficial for survival by reducing the magnitude of the inflammatory response.…”

Advantages and Dangers of Early Osteosynthesis of Femur in Polytrauma With Chest Injur

“…СВР определялась «первым ударом» и не была связана с выполнением операции. Но в эксперименте установ-лено, что после раннего интрамедуллярного остеосин-теза бедренной кости увеличивается выброс в кровь митохондриальной ДНК, уровень которой коррелирует с уровнями цитокинов (TNF-α и IL-10) в сыворотке крови и выраженностью патогистологических измене-ний в легких [39].…”