An increase in myeloid cells after severe injury is associated with normal fracture healing: a retrospective study of 62 patients with a femoral fracture

Lillian Hesselink*, Okan W Bastian, Marjolein Heeres, Maarten Ten Berg, Albert Huisman, Imo E Hoefer, Wouter W van Solinge, Leo Koenderman, Karlijn J P van Wessem, Luke P H Leenen, Falco Hietbrink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background and purpose—Nonunion is common in femoral fractures. Previous studies suggested that the systemic immune response after trauma can interfere with fracture healing. Therefore, we investigated whether there is a relation between peripheral blood cell counts and healing of femur fractures. Patients and methods—62 multi-trauma patients with a femoral fracture presenting at the University Medical Centre Utrecht between 2007 and 2013 were retrospectively included. Peripheral blood cell counts from hematological analyzers were recorded from the 1st through the 14th day of the hospital stay. Generalized estimating equations were used to compare outcome groups. Results—12 of the 62 patients developed nonunion of the femoral fracture. The peripheral blood-count curves of total leukocytes, neutrophils, monocytes, lymphocytes, and platelets were all statistically significantly lower in patients with nonunion, coinciding with significantly higher CRP levels during the first 2 weeks after trauma in these patients. Interpretation—Patients who developed femoral nonunion after major trauma demonstrated lower numbers of myeloid cells in the peripheral blood than patients with normal fracture healing. This absent rise of myeloid cells seems to be related to a more severe post-traumatic immune response.

Original languageEnglish
Pages (from-to)585-590
Number of pages6
JournalActa Orthopaedica
Volume89
Issue number5
Early online date6 Aug 2018
DOIs
Publication statusPublished - 3 Sept 2018

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • C-Reactive Protein/metabolism
  • Erythrocyte Count
  • Female
  • Femoral Fractures/blood
  • Fracture Fixation/methods
  • Fracture Healing/physiology
  • Fractures, Ununited/blood
  • Humans
  • Injury Severity Score
  • Leukocyte Count
  • Male
  • Middle Aged
  • Myeloid Cells/pathology
  • Platelet Count
  • Retrospective Studies
  • Young Adult

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