Abstract
Satisfactory healing of soft tissue wounds and bone fracture requires activation and response of the immune system. Our previously reported laboratory observations revealed that proper healing of the long bone fractures corresponds with an increased mass of lymph nodes (LNs) draining the site of injury when compared with contralateral limb, whereas delayed fracture healing is characterized by decreased mass of the regional LNs. Aim of the study was to investigate whether an image of LNs may be an indicator of the kinetics of fracture healing.
Patients & Methods. Observations were carried out in two groups of adult patients with closed not infected fractures of lower extremities healing uneventfully (n=15) and fractures with delay healing (n=17, diagnosed clinically and with X-ray and CT scans). Patients with venous thromboses were excluded. Morphologic structures of the lymphatic system of lower extremities were visualized on lymphoscintigraphies with 99mTc-Nanocol. Lymphoscintigrams were scanned and evaluated quantitatively. The surface of iliac lymph nodes of the fractured and contralateral limb served to calculate of LNs size index. Differences between groups were evaluated using Student-T-test.
Results. The surfaces of inguinal LNs of the fractured limb in patients with uneventful healing fractures were larger than in contralateral limbs (index=1.67±0.57), whereas in patients with non-union the inguinal LNs surface was smaller (index=0.49±0.45, p=0,00000031).
Conclusions. Lymphoscintigraphic pictures of the lymph nodes draining the site of injury reflect to a certain extent regenerative processes. Speculatively, observed changes depend upon molecular mediators drained with the lymph from fracture gap. The method can be used for non-invasive monitoring of the fracture repair process.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
