Abstract
The evaluation of trauma after surgery through objective analysis of biochemical markers can help in selecting the most appropriate therapy. Thus the aim of the study was the evaluation of the concentration of selected inflammatory cytokines (IL-6, IL-8, CXCL5, IL-33), C-reactive protein (CRP), and damaged-associated molecular patterns (DAMPs): HMGB-1, HSP-70 in the plasma of children in response to bone fracture and 12-14 hours after subsequent surgery performed by closed reduction with percutaneous Kirschner wire fixation (CRKF). The study will answer the question if the CRFK procedure leads to excessive production of inflammatory and damage markers. Blood samples from 29 children with distal forearm fractures were collected 30 min. before CRKF procedure and 12-14 hours after performance of the procedure. The control group was composed of 17 healthy children. IL-6 and CRP concentrations were analyzed using routinely performed in vitro diagnostics tests; the remaining proteins were analyzed with the use of the ELISA method. Increased values of IL-6, CRP, and HSP-70 represented an early inflammatory response to distal forearm fractures classified as SH-II type according to the Salter-Harris classification system. However, the median CRP concentration was within the reference values not indicative of inflammation. The CRKF procedure may be a good solution for the treatment of bone fractures, as damaged associated molecular patterns – HMGB-1 and HSP-70 – did not significantly differ 12-14 hours after the approach was applied as compared to the control group. Moreover, the increase in IL-6 concentration after the CRKF procedure was 1.5-fold to the level before CRKF, while the increase of this marker in response to the distal forearm fracture was 4.3-fold compared to the control group. Based on this data, it appears reasonable to suggest that the CRKF approach caused less damage and inflammatory response in comparison to the response to the fracture itself.
Highlights
Distal forearm fractures caused by falls around the home or during sports activities are the most common injuries in pediatric traumatology [1]
It was further confirmed by Baht et al [15], who postulate that during the inflammatory phase neutrophils secrete a wide range of cytokines and chemokines (IL-1, IL-6, IL-10, TNFa, CCL2, CXCL-1a, MIP-1) to attract monocytes, which are precursors of macrophages playing an integral part in bone homeostasis and bone fracture repair
The authors showed that serum IL-6 concentration, contrary to the IL-8 concentration, significantly increased 14 hours after trauma compared to the control group [16]
Summary
Distal forearm fractures caused by falls around the home or during sports activities are the most common injuries in pediatric traumatology [1]. There is no standard treatment for pediatric distal forearm fractures. They can be treated surgically or non-operatively. The treatment method depends on the degree of angulation, the patient’s age, the type of fracture, and the surgeon’s preference Most of these fractures, especially in children under 10 years of age and angulation less than 10-20 degrees, are treated non-operatively by closed reduction and cast immobilization. Significantly displaced and unstable fractures should be treated surgically by Close Reduction and Internal Fixation (CRIF). Unstable distal forearm fractures Close Reduction and the distal radius percutaneous Kirschner wire Fixation (CRKF) have been advocated as a safe and reliable technique for maintaining the alignment of the fracture and avoiding redisplacement and further manipulation [2]. Lieber et al [3] suggest a trans epiphyseal intramedullary K-wire fixation in unstable diametaphyseal forearm fractures as a quick, minimally invasive, and technically easy treatment option
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