Early Internal Fracture Fixation Prevents Bacterial Translocation

Abstract

The aim of our study was to determine whether early internal fixation of major bone fractures helps prevent bacterial translocation in patients with multitrauma. Thirty-seven Sprague-Dawley rats were divided into three groups: (1) anesthesia only (n = 12); (2) the trauma group: tibia and femur fractures and moderate head trauma under anesthesia (n = 14); and (3) the fixation group: fixation of tibia and femur fractures and moderate head trauma under anesthesia (n = 11). After 24 hours, mesenteric lymph nodes, liver, spleen, and systemic blood samples were quantitatively cultured. The terminal ileum was assessed histopathologically. The incidence of bacterial translocation was less in the anesthesia group (two of 12 rats) and the fixation group (two of 11 rats) than in the trauma group (10 of 14 rats). The number of organs containing viable bacteria was significantly lower in the fixation group than in the trauma group. Histopathologically, villous architecture was preserved mostly in the fixation group; however, marked mucosal damage was detected in the trauma group. Our data suggest early internal fixation of long bone fractures in polytraumatized experimental animals with head injury results in preservation of the intestinal mucosal barrier and decreased bacterial translocation from the gut.

Increased IgA-mediated responses to the gut paracellular pathway and blood–brain barrier proteins predict delirium due to hip fracture in older adults

“…Significant evidence of the disruption of the gastrointestinal (gut) and blood–brain barriers (BBB) has been observed in individuals with neurocognitive impairments, autism, and schizophrenia ( 24 , 42 , 59 , 102 ). Notably, certain conditions that increase the likelihood of delirium are also linked to both increased intestinal permeability and the translocation of LPS or bacteria from the gut into the bloodstream causing tissue damage ( 103 ), bone fracture ( 104 , 105 ), aging ( 106 ), stroke ( 107 ), sepsis ( 108 , 109 ), liver failure ( 110 , 111 ), uremia ( 112 , 113 ), alcohol ( 114 , 115 ), malnutrition ( 116 , 117 ), and psychological stressors ( 118 , 119 ). Furthermore, these risk variables were also linked to BBB disintegration ( 120 – 127 ), which is considered a prevalent and significant contributing factor to delirium ( 128 ).…”

Sterile post‐traumatic immunosuppression

“…Therefore, although sanitation has been improved in the hospitals, an equivalent phenomenon of post‐traumatic deaths from systemic infections persists to this day. Recent in vivo studies confirmed the trauma‐associated translocation of endogenous bacteria from the gut following sterile head injury, 6 , 7 indicating another source of PTI.…”

“…This may trigger the translocation of bacteria from the gut to the circulation, and increase the risk of systemic PTI. However, whether PTI and increase gut permeability are directly associated with each other, remains to be investigated 6 , 7 , 92 …”

“…However, whether PTI and increase gut permeability are directly associated with each other, remains to be investigated. 6,7,92 Figure 1 schematically represents an overview of these complex interactions and attempts to summarize the literature review undertaken. On the basis of the current understanding, Table 3 attempts to compare the key features of sterile trauma in the inflammation phase versus the immunosuppressive phase.…”

“…Recent studies indicate that PTI following surgical trauma enhances patients’ vulnerability to acquire exogenous infections from the hospital or endogenous infections associated with microbial translocations from the gut 6 , 7 , 60 , 93 , 94 , 95 , 96 . Different forms of nosocomial infections may occur in the immuno‐compromised patient in different body compartments 97 .…”