Purpose

The aim of this study was to investigate whether growth factors essential for fracture healing are released in the immediate aftermath following fracture and whether reaming of IM cavity causes increased liberation of these autocoids.

Introduction: The health benefits of physical exercise are well recognised. In recent years the department of health has been encouraging the UK population to exercise more. We aimed to determine if there was any change in the number and pattern of sport and exercise related injuries attending a city Emergency Department (ED) over the past two decades.

Methods: We undertook a prospective comparative study of patients attending an ED over two time periods: Aug 85 – April 86 and Aug 04 – April 05. All identified patients had a standardised proforma inserted into their notes which was prospectively completed by the attending clinician at the time of consultation.

Results: We observed a 35% increase in sporting injuries over the 19 year period (1000 injuries out of 37036 new patients vs 1351 out of 37526, p< 0.0001). The total number of new patients attending the ED remained unchanged during this time. Males remain the majority of patients with sports injuries (86%). We noted a change in age distribution with a relative increase in patients under 16 yrs (p< 0.0001), a decrease in 16–24 yrs (p=0.0002) and an increase in patients over 40yrs (p< 0.001). There was a significant reduction in patients presenting out of hours and a significant increase in the delay to presenting at ED with the majority of patients presenting over 4 hours after the injury. Football remains the commonest cause of sports injury accounting for half of all sports injuries, followed by rugby but there has been a relative decline in skiing, martial arts jogging and squash as a cause of injury and a significant increase in injuries due to snowboarding, skateboarding and basketball.

Conclusion: There has been an increase in the number of sports injuries attending hospital, which may represent a general increase in sport and exercise participation among our population.

Purpose: The role of the pro-inflammatory cytokine HMGB1 (alarmins) has not been investigated in the clinical setting. This study aims to assess its relationship to IL-6 release, ISS, and to quantify the second hit phenomenon after femoral nailing.

Methods: 22 (13 males, mean age 37.5y) consecutive patients were entered into this prospective randomised trial. All patients underwent stabilisation of the femoral shaft fracture with reamed (10 patients) or unreamed nailing. Patient demographics, ISS, and complications were recorded prospectively. Peripheral blood samples were collected on admission, induction of anaesthesia, entry into femoral canal, wound closure and on day 1, 3, and 6. Serum HMGB1 and IL-6 concentrations were measured using ELISAs. 6 healthy volunteers formed the control group.

Results: The median ISS was 14.5 (9–29). Admission median HMGB1 and IL-6 concentrations were 7.2 ng/ml and 169 pg/ml respectively. A direct correlation was observed between ISS and IL-6 concentrations. HMGB1 concentrations reached to peak levels on day-6. On the contrary, the median concentration of IL-6 peaked around day 1 postoperatively (reamed: 780 vs. unreamed: 376 pg/ml) and then showed a downward trend. The median increase of HMGB1 by day 6 was 4.21ng/ml in the reamed and 2.98ng/ml in the unreamed population; the median increase of IL-6 by day 1 measured 462 pg/ml and 232 pg/ml in the respective groups.

Conclusion: Femoral nailing and reaming induces a second hit response as supported by the post-operative increased levels of IL-6. There appears to be an inverse relationship in the concentrations of IL-6 and HMGB-1. Serum concentration of IL-6 unlike HMGB-1 strongly correlate with ISS. While IL-6 has been suggested as a marker of assessment of the early inflammatory response, alarmins can provide useful information at the later stage of an evolving immune-inflammatory process.

Purpose: Growth factors are released and circulate in peripheral blood after fracture. The purpose of this study was to characterize the early systemic release of several growth factors following accidental fractures and surgery.

Methods: 14 patients (8 male and 6 female) suffering from lower limb long bone fractures were prospectively included in the study. The mean age was 34 years (range 18-61). In all patients the time from fracture occurrence till operation was less than 24 hours. Peripheral blood samples were collected on patients’ admission, induction, and postoperatively at 1, 3 and 5 days. Serum was extracted and using Elisa colorimetric assays the concentration of Platelet Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF), Insulin-like Growth Factor I (IGF-1) and Transforming Growth Factor beta 1 (TGF-b1) was measured.

Results: From fracture occurrence till induction for surgery a substantial decreased was observed (VEGF concentration was decreased by 189%, PDGF was decreased by 363%, TGF-b1 was decreased by 247 % and IGF-1 was decreased only by 25%. Surgery itself decreased VEGF peripheral levels by a further 50% and PDGF by 40 % while IGF and TGF-b1 levels remained unchanged. During the first post-operative day the levels of VEGF were increased by 82%, TGF-b1 and IGF-1 remained constant and PDGF was further decreased by 20%. Between the 1st and 3rd postoperative days VEGF was increased by 132%, PDGF by 220% and TGF-b1 by 230 %. During this period, IGF-1 was decreased by 20 %. Finally, during the 3rd to 5th postoperative day, the levels of all growth factors continue to increase.

Conclusion: This study illustrates the early pattern of release of 4 growth factors following fractures and surgery. A substantial decreased during the first 24 hours was noted but thereafter an upward trend was observed. This data provide insight into the levels and kinetics of growth factors before and after surgery of fractures.