Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk
“…This difference can be mainly attributed to the low rate of ILF + mTBI patients with ankle and distal radius fractures, compared to the ILF patients. Given the higher incidence of mTBI in fractures occurring proximally to the head (Jodoin et al, 2016), risks of suffering from a mTBI are rare in individuals treated for ankle and distal radius fractures.Fig. 2Participant selection flowchart.…”
Section: Resultsmentioning
confidence: 99%
“…All participants included in this study were selected from a previous sample recruited consecutively from a single orthopedic clinic of a Level 1 Trauma Hospital to evaluate the incidence rate of mTBI among ILF patients (For more details; Jodoin et al, 2016). Each participant has consented to grant access to their research data for future studies.…”
Section: Methodsmentioning
confidence: 99%
“…MTBIs account for approximately 70–90% of all TBIs sustained and are frequent among patients who suffered from fractures, with an incidence rate estimated at 23% (Cassidy et al, 2004; Jodoin et al, 2016). Although considered the mildest form of TBIs, a growing body of evidence shows that concomitant mTBI can have a significant impact on recovery in patients with fractures, highlighting the importance of considering the interaction between these two injuries (Jodoin et al, 2017a, Jodoin et al, 2017b).…”
Section: Introductionmentioning
confidence: 99%
“…To our knowledge, the association between mTBI and HO has not been investigated. Lack of medical follow-ups after mTBIs, subclinical HO signs associated with less severe accidents as well as underdiagnosed mTBI in trauma patients presenting with fractures could partly underlie this lack of scientific interest (Jodoin et al, 2016). Here, we tested whether isolated limb fracture patients (ILF) presenting with a concomitant mTBI have a higher incidence rate of HO when compared to ILF patients without a mTBI.…”
Objectives
This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated limb fracture (ILF) and a concomitant mild traumatic brain injury (mTBI).
Methods
The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph.
Results
The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X
2
= 6.50;
p
= 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X
2
= 3.69;
p
= 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055;
p
= 0.05) but not in ILF patients (F = 0.823;
p
= 0.37).
Conclusions
Study findings suggest that rates of HO are significantly higher proximally to fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.
“…This difference can be mainly attributed to the low rate of ILF + mTBI patients with ankle and distal radius fractures, compared to the ILF patients. Given the higher incidence of mTBI in fractures occurring proximally to the head (Jodoin et al, 2016), risks of suffering from a mTBI are rare in individuals treated for ankle and distal radius fractures.Fig. 2Participant selection flowchart.…”
Section: Resultsmentioning
confidence: 99%
“…All participants included in this study were selected from a previous sample recruited consecutively from a single orthopedic clinic of a Level 1 Trauma Hospital to evaluate the incidence rate of mTBI among ILF patients (For more details; Jodoin et al, 2016). Each participant has consented to grant access to their research data for future studies.…”
Section: Methodsmentioning
confidence: 99%
“…MTBIs account for approximately 70–90% of all TBIs sustained and are frequent among patients who suffered from fractures, with an incidence rate estimated at 23% (Cassidy et al, 2004; Jodoin et al, 2016). Although considered the mildest form of TBIs, a growing body of evidence shows that concomitant mTBI can have a significant impact on recovery in patients with fractures, highlighting the importance of considering the interaction between these two injuries (Jodoin et al, 2017a, Jodoin et al, 2017b).…”
Section: Introductionmentioning
confidence: 99%
“…To our knowledge, the association between mTBI and HO has not been investigated. Lack of medical follow-ups after mTBIs, subclinical HO signs associated with less severe accidents as well as underdiagnosed mTBI in trauma patients presenting with fractures could partly underlie this lack of scientific interest (Jodoin et al, 2016). Here, we tested whether isolated limb fracture patients (ILF) presenting with a concomitant mTBI have a higher incidence rate of HO when compared to ILF patients without a mTBI.…”
Objectives
This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated limb fracture (ILF) and a concomitant mild traumatic brain injury (mTBI).
Methods
The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph.
Results
The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X
2
= 6.50;
p
= 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X
2
= 3.69;
p
= 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055;
p
= 0.05) but not in ILF patients (F = 0.823;
p
= 0.37).
Conclusions
Study findings suggest that rates of HO are significantly higher proximally to fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.
“…It is not uncommon for patients with orthopedic injuries to have a concomitant undiagnosed mild TBI, particularly with upper limb fractures. 7 If symptoms are not carefully and prospectively assessed, patients will not be correctly classified. Curiously, the MRI reports of 30% of the orthopedic controls in the Posti study showed some kind of abnormality.…”
blood-based traumatic brain injury (TBI) biomarkers has exploded over the last two decades and continues to grow at an unwavering pace. Commercialization of these biomarkers is ongoing, with a number of companies seeking United States Food and Drug Administration (FDA) approval to market their tests for clinical applications. Although there are an abundance of articles being published, many lack the rigorous methods and reporting required to adequately evaluate these markers for clinical use. Too often, there are inadequate sample sizes, inappropriate control groups and outcome measures, variable definitions of TBI, and differences in when samples are drawn relative to time of injury. Importantly, variability in how samples are processed and performance characteristics of the assays themselves are rarely known or incompletely described. It is time to raise the bar for how bloodbased TBI biomarker research is conducted, and to encourage researchers, laboratories, and companies (producing and/or running assays) to perform at a higher standard. In the recently published study by Posti and coworkers, the performance of glial and neuronal biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) was compared between CT negative mild TBI patients (based on American Congress of Rehabilitation Medicine [ACRM] criteria) 1 and orthopedic control patients. 2 Proteomic analyses of GFAP and UCH-L1 were conducted at Randox Laboratories Ltd. (Crumlin, County Antrim, United Kingdom) with Randox Biochip technology. Blood samples were drawn, when available, on days 1, 2, 3, and 7 after patients' admission to the hospital, and at a late time point somewhere between 3 and 10 months after the injury. The authors found no significant differences in the concentrations of GFAP or UCH-L1 between mild TBI patients with a negative CT (n = 55) and orthopedic control patients (n = 44). This is in contrast to the findings from previous studies comparing orthopedic controls to mild TBI patients (also based on ACRM definition) 1 with and without intracranial lesions on CT. 3-6 In a recently published study in JAMA Neurology, which enrolled 584 trauma patients within 4 h of injury, GFAP (p < 0.001) and UCH-L1 (p = 0.049) were both significantly higher in CT nega
Traumatic brain injury (TBI) is characterized by cellular damage and inflammation in lesioned brain tissue. Ferulic acid has been shown to have a melioration effect on neurological functions. However, the active pharmacological effects and the underlying mechanisms of ferulic acid against TBI remain unclear. On the basis of network pharmacology and molecular docking methodology, this study aimed to investigate the beneficial effects of ferulic acid in treating TBI, and characterized the detailed biotargets and mechanisms of these actions. The identified core targets were validated via in silico simulation. We identified 91 overlapping targets associated with ferulic acid and TBI. In‐silico simulation analysis validated the putative core targets of tumor protein p53, mitogen‐activated protein kinase (MAPK) 1, and estrogen receptor 1. The Gene Ontology‐enriched annotations and findings were largely associated with cell proliferation, apoptosis, and inflammation in nerve cells. Additional Kyoto Encyclopedia of Genes and Genomes enrichment analysis unmasked the pharmacological pathways of ferulic acid in treating TBI, including the MAPK signaling pathway and hypoxia‐inducible factor‐1 signaling pathway. Bioinformatic analyses and findings provide a new preclinical strategy for revealing the core targets and network pathways of ferulic acid in treating TBI. Moreover, some bioinformatic findings were computationally validated in silico for exhibiting the neuroprotective action of ferulic acid against TBI.
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