Tight junction disruption through activation of the PI3K/AKT pathways in the skin contributes to blister fluid formation after severe tibial plateau fracture

Abstract

Background: Acute compartment syndrome (ACS) is an orthopedic emergency that commonly occurs after severe tibial plateau fracture. Fracture blisters form on the skin, and it was found in our previous study that when blisters form, the compartment pressure significantly decreases. However, the potential mechanism underlying this pressure decrease has not yet been elucidated.Methods: To obtain a comprehensive understanding of the changes that occur after blister formation on the skin, the changes in tight junction expression in the skin after tibial plateau fracture were observed. Blister samples and normal skin were collected from patients with bicondylar tibial plateau fractures with or without blisters. The epidermis thickness was measured, and the difference in the levels of K1, K5, K10, and skin barrier proteins such as claudin 1, claudin 2, and occludin between the two groups was evaluated by immunochemistry analysis, immunofluorescence, Western blotting, and qPCR.Results: The skin was thinner and the levels of K1, K5, and K10 were significantly decreased in blistered skin. Furthermore, the PI3K/AKT pathway was found to be activated, and the tight junction expression was significantly decreased in blistered skin. This indicates that the paracellular pathway, which is essential for accelerating fluid accumulation in blisters and indirectly decreases compartment pressure, was activated.Conclusion: Changes in the tight junction expression after blister formation may underlie blister fluid formation and indirectly explain the decrease in compartment pressure under blistered skin after severe tibial plateau fracture.

Inflammation-related proteomics demonstrate landscape of fracture blister fluid in patients with acute compartment syndrome

“…Acute Compartment Syndrome (ACS) is an orthopedic emergency that commonly occurs when a severe lower limb fracture causes increased pressure within a muscle compartment that compromises the surrounding tissue. Fracture blisters (FBs) typically form in conjunction with ACS, and Guo ( 1 ) previously found that the formation of blisters results in a significant decrease in compartment pressure. However, the mechanism of FBs formation underlying this decrease in pressure has not yet been elucidated.…”

Effect of hemocoagulase on the coagulation parameters, blood transfusion volume and bleeding volume of patients with severe traumatic fractures

“…In addition, patients with severe traumatic fractures have been reported to have clinically abnormal coagulation functions such as hypercoagulability and hyperfibrinolysis, leading to adverse reactions including venous thrombosis and gastrointestinal bleeding [5,6]. These conditions not only affect the surgical treatment of patients, but also are extremely detrimental to their postoperative recovery [7,8]. Therefore, how to effectively control the postoperative bleeding volume and improve coagulation functions in patients with severe traumatic fractures is an important issue that needs to be addressed in the clinical treatment and postoperative recovery of these patients.…”