Immediate Microcirculatory Derangements in Skeletal Muscle and Periosteum after Closed Tibial Fracture

Zhang, Li; Bail, Hermann Josef; Mittlmeier, Thomas; Haas, Norbert; Schaser, K.-D.

doi:10.1097/01.ta.0000025796.74054.5b

Cited by 32 publications

(29 citation statements)

References 20 publications

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“…We found a significant elevated fraction of rolling leukocytes and leukocyte adhesion per vessel surface immediately after chamber implantation, which decreased over the observation period reaching a steady state at day twelve, while leukocyte flux in vessels remained unaltered. The result of leukocyte rolling fraction measured on day of chamber implantation corroborates observations measured in periosteum of rats after surgical exposure [63].…”

Section: Discussionsupporting

confidence: 84%

“…The initially increased permeability as well as LEIs after bone chamber implantation are likely due to the surgical manipulation at the cortical bone with cell injuries and consecutive aseptic inflammatory reaction [ 1 1,16, 24,33,57,63]. The decrease in these parameters to a steady state reflects therefore the return to the normal microcirculatory environment, which was reached 12 days after femur window implantation and should be considered using a chamber implantation for longterm observations.…”

Section: Discussionmentioning

confidence: 99%

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Femur window—a new approach to microcirculation of living bone in situ

Hansen-Algenstaedt

Schaefer

Wolfram

et al. 2005

Journal Orthopaedic Research

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Background: The processes of osteogenesis, bone remodelling, fracture repair and metastasis to bone are determined by complex sequential interactions involving cellular and microcirculatory parameters. Consequently studies targeting the analysis of microcirculatory parameters on such processes should mostly respect these complex conditions. However these conditions could not yet be achieved in vitro and therefore techniques that allow a long-term observation of functional and structural parameters of microcirculation in bone in vivo at a high spatial resolution are needed to monitor dynamic events, such as fracture healing, bone remodelling and tumor metastasis.Methods: We developed a bone chamber implant (femur window) for long-term intravital microscopy of pre-existing bone and its microcirculation at an orthotopic site in mice preserving the mechanical properties of bone. After bone chamber implantation vascular density, vessel diameter, vessel perfusion, vascular permeability and leukocyte-endothelial interactions (LEIS) in femoral bone tissue of c57-black mice ( n = 11) were measured quantitatively over 12 days using intravital fluorescence microscopy. Furthermore a model for bone defect healing and bone metastasis in the femur window was tested.Results: Microvascular permeability and LEIS showed initially high values after chamber implantation followed by a significant decrease to a steady state at day 6 and 12, whereas structural parameters remained unaltered. Bone defect healing and tumor growth was observed over 12 and 90 days respectively. Conclusion:The new femur window design allows a long-term analysis of structural and functional properties of bone and its microcirculation quantitatively at a high spatial resolution. Altered functional parameters of microcirculation after surgical procedures and their time dependent return to a steady state underline the necessity of long-term observations to achieve unaltered microcirculatory parameters. Dissection of the complex interactions between bone and microcirculation enables us to evaluate physiological and pathological processes of bone and may give new insights especially in dynamic events e.g. fracture healing, bone remodeling and tumor metastasis.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Femur window—a new approach to microcirculation of living bone in situ

Hansen-Algenstaedt

Schaefer

Wolfram

et al. 2005

Journal Orthopaedic Research

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“…Upon a 20-min stabilization period after completion of surgery, in vivo microscopy of the soleus muscle was performed, as previously described for the EDL. [14][15][16][17] To consider the heterogeneous morphology of the traumatized muscle, a classification system, as recently published by our group 18 was used, considering three zones. Zone 1 (z1) was defined as the central muscle area with entrance of the neurovascular structures.…”

Section: Animal Model and Experimental Groupsmentioning

confidence: 99%

Erythropoietin improves functional and histological recovery of traumatized skeletal muscle tissue

Rotter

Menshykova

Winkler

et al. 2008

Journal Orthopaedic Research

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Apart from its hematopoietic effect, erythropoietin (EPO) is known as pleiotropic cytokine with anti-inflammatory and antiapoptotic properties. Here, we evaluated for the first time the EPO-dependent regeneration capacity in an in vivo rat model of skeletal muscle trauma. A myoblast cell line was used to study the effect of EPO on serum deprivation-induced cell apoptosis in vitro. A crush injury was performed to the left soleus muscle in 80 rats treated with either EPO or saline. Muscle recovery was assessed by analysis of contraction capacities. Intravital microscopy, BrdU/laminin double immunohistochemistry and cleaved caspase-3 immunohistochemistry of muscle tissue on days 1, 7, 14, and 42 posttrauma served for assessment of local microcirculation, tissue integrity, and cell proliferation. Serum deprivation-induced myoblast apoptosis of 23.9 AE 1.5% was reduced by EPO to 17.2 AE 0.8%. Contraction force analysis in the EPO-treated animals revealed significantly improved muscle strength with 10-20% higher values of twitch and tetanic forces over the 42-day observation period. EPO-treated muscle tissue displayed improved functional capillary density as well as reduced leukocytic response and consecutively macromolecular leakage over day 14. Concomitantly, muscle histology showed significantly increased numbers of BrdU-positive satellite cells and interstitial cells as well as slightly lower counts of cleaved caspase-3-positive interstitial cells. EPO results in faster and better regeneration of skeletal muscle tissue after severe trauma and goes along with improved microcirculation. Thus, EPO, a compound established as clinically safe, may represent a promising therapeutic option to optimize the posttraumatic course of muscle tissue healing.

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“…The vascularlity of the soft tissue sleeve surrounding the distal tibia is tenuous [6][7][8][9][10] and aggressive handling with extensive periosteal stripping will disturb the nutrition to the myocutaneous tissue and underlying bone.…”

Section: Introductionmentioning

confidence: 99%

Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

McCann

Jackson

Mitchell

et al. 2010

International Orthopaedics (SICOT)

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A series of 49 pilon fractures in a tertiary referral centre treated definitively by open reduction and internal fixation have been assessed and the complications of such injuries examined. A retrospective analysis of case notes, radiographs and computerised tomographs over a sevenyear period from 1999-2006 was performed. Infection was the most common postoperative problem. There were seven cases of superficial infection. There was a single case of deep infection requiring intravenous antibiotics and removal of metalwork. Other notable complications were those of secondary osteoarthritis (three cases) and malunion (one case). The key finding of this paper is the 2% incidence of deep infection following the direct operative approach to these fractures. The traditional operative approach to such injuries (initially advocated by Rüedi and Allgöwer in Injury 2:92-99, 1969) consisted of extensive soft tissue dissection to gain access to the distal tibia. Our preferred method is to access the tibia via the "direct approach" which involves direct access to the fracture site with minimal disturbance of the soft tissue envelope. We therefore believe that open reduction and internal fixation of pilon fractures via the direct approach to be a safe technique in the treatment of such devastating injuries.

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Immediate Microcirculatory Derangements in Skeletal Muscle and Periosteum after Closed Tibial Fracture

Cited by 32 publications

References 20 publications

Femur window—a new approach to microcirculation of living bone in situ

Femur window—a new approach to microcirculation of living bone in situ

Erythropoietin improves functional and histological recovery of traumatized skeletal muscle tissue

Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

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