Monotrauma is associated with enhanced remote inflammatory response and organ damage, while polytrauma intensifies both in porcine trauma model

Störmann, Philipp; Wagner, Nils; Köhler, Kernt; Auner, B.; Simon, Tim Philipp; Pfeifer, Roman; Horst, Klemens; Pape, Hans-Christian; Hildebrand, Frank; Wutzler, Sebastian; Marzi, Ingo; Relja, Borna

doi:10.1007/s00068-019-01098-1

Cited by 28 publications

(27 citation statements)

References 45 publications

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“…In agreement, Störmann et al reported that an isolated fracture resulted in an enhanced PMNL in ltration into the liver and lung. However, in contrast to our ndings for the musculature, polytrauma resulted in an intensi cation of PMNL invasion in those organs, which underlines the high immunological activity of the liver and lungs [28].…”

Section: Discussioncontrasting

confidence: 99%

Fracture Fixation Strategy and Specific Muscle Tissue Availability of Neutrophilic Granulocytes Following Mono- and Polytrauma: Intramedullary Nailing Vs. External Fixation of Femoral Fractures

Greven

Horst

Qiao

et al. 2020

Preprint

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Background: In the stabilization of femoral fractures in mono- and polytrauma, clinical practice has shown better care through intramedullary nailing. However, the reason why this is the case is not fully understood. In addition to concomitant injuries, the immunological aspect is increasingly coming to the fore. Neutrophil granulocytes (PMNL), in particular, seem to be associated with the fracture healing processes and are of great interest in various studies. For this reason, the early phase after fracture (up to 72 h after trauma) near the fracture zone in muscle tissue was investigated in a pig model.Material and Methods: A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemorrhagic shock, liver laceration, and femur fracture) was used to demonstrate the immunological situation through muscle biopsies and their analysis by histology and qRT-PCR during a 72 h follow up phase. Two stabilization methods were used (intramedullary nail vs. external fixator) and the two trauma groups were compared to a sham group that was not traumatized.Results: The fracture itself had a significant influence on pro-inflammatory cytokine concentrations, as cytokine levels were significantly higher on the traumatized side (T-side) than on the non-injured side (AT-side) (IL-6: 2 h p = 0.041, 24 h p = 0.0017; IL-8: 2 h p = 0.002, 24 h p = 0.029 and 48 h p = 0.008) in monotrauma. The severity of the overall trauma (mono- vs. polytrauma) also significantly increased local cytokine concentrations for monotrauma vs. polytrauma (at 2 h and 48 h, p = 0.003; p = 0.032). The immigration of neutrophil granulocytes into the muscle was also higher for monotrauma (mono- vs. polytrauma 15.52 ± 5.39 vs. 8.23 ± 3.36 [neutrophil/visual field]; p = 0.013).Conclusion: The reduction of PMNL infiltration into the nearby muscle tissue of a monotrauma femur fracture stabilized by intramedullary nailing supports the advantages found in everyday clinical practice and therefore underlines the usage of nailing. For the polytrauma situation, the fixation seems to play a minor role, possibly due to a generalized immune reaction.

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Section: Discussioncontrasting

confidence: 99%

Fracture Fixation Strategy and Specific Muscle Tissue Availability of Neutrophilic Granulocytes Following Mono- and Polytrauma: Intramedullary Nailing Vs. External Fixation of Femoral Fractures

Greven

Horst

Qiao

et al. 2020

Preprint

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“…S100b is also expressed in peripheral nervous tissue in addition to the CNS. Furthermore, muscle tissue, chondrocytes and adipocytes were identified to release S100b after injury [3]. TBI could only be detected with a predictive power of 67% in pediatric polytrauma patients with TBI and fracture of long bones [30].…”

Section: S100b Missing Diagnostic Value After Severe Traumamentioning

confidence: 98%

“…Polytrauma (PT) and severe traumatic brain injury (TBI) caused by road traffic accidents and falls are the main causes of death and disability in young patients under 45 years with immense socioeconomic impact through loss of productivity, medical and rehabilitation costs [ 1 , 2 ]. The treatment of patients with multiple organ injuries poses a particular challenge due to different injury patterns and severity, but also due to the complex immune response [ 3 ]. Post-traumatic exaggerated immunomodulation often leads to postinjury complications, multiple organ failure (MOF) or death and are predictors of mortality in trauma [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Severe Traumatic Brain Injury (TBI) Modulates the Kinetic Profile of the Inflammatory Response of Markers for Neuronal Damage

Schindler

Lustenberger

Woschek

et al. 2020

JCM

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The inflammatory response plays an important role in the pathophysiology of multiple injuries. This study examines the effects of severe trauma and inflammatory response on markers of neuronal damage. A retrospective analysis of prospectively collected data in 445 trauma patients (Injury Severity Score (ISS) ≥ 16) is provided. Levels of neuronal biomarkers (calcium-binding Protein B (S100b), Enolase2 (NSE), glial fibrillary acidic protein (GFAP)) and Interleukins (IL-6, IL-10) in severely injured patients (with polytrauma (PT)) without traumatic brain injury (TBI) or with severe TBI (PT+TBI) and patients with isolated TBI (isTBI) were measured upon arrival until day 5. S100b, NSE, GFAP levels showed a time-dependent decrease in all cohorts. Their expression was higher after multiple injuries (p = 0.038) comparing isTBI. Positive correlation of marker level after concomitant TBI and isTBI (p = 0.001) was noted, while marker expression after PT appears to be independent. Highest levels of IL-6 and -10 were associated to PT und lowest to isTBI (p < 0.001). In all groups pro-inflammatory response (IL-6/-10 ratio) peaked on day 2 and at a lower level on day 4. Severe TBI modulates kinetic profile of inflammatory response by reducing interleukin expression following trauma. Potential markers for neuronal damage have a limited diagnostic value after severe trauma because undifferentiated increase.

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“…The main reasons for death in those patients are typically severe multiple trauma following traffic accidents and (isolated) severe traumatic brain injuries (TBI) after falls, especially in older age [1,2]. The treatment of multiple injured patients is complex, especially due to the presence of injuries in different parts of the body and the time-critical initial treatment [3,4]. The care for severely injured trauma patients has changed during recent decades and is currently based on strict guidelines.…”

Section: Introductionmentioning

confidence: 99%

Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma

Schindler

Woschek

Verboket

et al. 2020

JCM

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Background: The treatment of severely injured patients, especially in older age, is complex, and based on strict guidelines. Methods: We conducted a retrospective study by analyzing our internal registry for mortality risk factors in deceased trauma patients. All patients that were admitted to the trauma bay of our level-1-trauma center from 2014 to 2018, and that died during the in-hospital treatment, were included. The aim of this study was to carry out a quality assurance concerning the initial care of severely injured patients. Results: In the 5-year period, 135 trauma patients died. The median (IQR) age was 69 (38–83) years, 71% were male, and the median (IQR) Injury Severity Score (ISS) was 25 (17–34) points. Overall, 41% of the patients suffered from severe traumatic brain injuries (TBI) (AIShead ≥ 4 points). For 12.7%, therapy was finally limited owing to an existing patient’s decree; in 64.9% with an uncertain prognosis, a ‘therapia minima’ was established in consensus with the relatives. Conclusion: Although the mortality rate was primarily related to the severity of the injury, a significant number of deaths were not exclusively due to medical reasons, but also to a self-determined limitation of therapy for severely injured geriatric patients. The conscientious documentation concerning the will of the patient is increasingly important in supporting medical decisions.

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Monotrauma is associated with enhanced remote inflammatory response and organ damage, while polytrauma intensifies both in porcine trauma model

Cited by 28 publications

References 45 publications

Fracture Fixation Strategy and Specific Muscle Tissue Availability of Neutrophilic Granulocytes Following Mono- and Polytrauma: Intramedullary Nailing Vs. External Fixation of Femoral Fractures

Fracture Fixation Strategy and Specific Muscle Tissue Availability of Neutrophilic Granulocytes Following Mono- and Polytrauma: Intramedullary Nailing Vs. External Fixation of Femoral Fractures

Severe Traumatic Brain Injury (TBI) Modulates the Kinetic Profile of the Inflammatory Response of Markers for Neuronal Damage

Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma

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