Abstract
Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of ≥10 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.
Highlights
Despite enormous efforts in research, monetary investments and extensive observation in everyday clinical practice, bone healing is still not fully understood
No clinical data supported the pre‐clinical reports of impaired fracture healing and reduced callus formation in long bones when accompanied by thoracic trauma
Recknagel et al revealed that a chest trauma triggers a post‐traumatic systemic inflammation and changes the callus formation and composition [13]
Summary
Despite enormous efforts in research, monetary investments and extensive observation in everyday clinical practice, bone healing is still not fully understood. Accelerated fracture healing due to concomitant traumatic brain injury (TBI) has been demonstrated in clinical and pre‐clinical studies [6,7,8]. Those data suggested a systemic interplay in multiple injuries leading to either an adverse or a beneficial effect on long bone fracture healing. No clinical data supported the pre‐clinical reports of impaired fracture healing and reduced callus formation in long bones when accompanied by thoracic trauma. Differences in pulmonary oxygenation and application of an antagonist against the C5a receptor, which plays a crucial role in the complement cascade, were shown to reduce the diminishing effect of thoracic trauma on fracture healing [14,15]
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