Fri., 10/19/07 Basic Science, Paper #41, 4:30 pm OTA-2007
Growth Factor Release following Femoral Nailing
Peter V. Giannoudis, MD1 (n); Ippokratis Pountos, MD1 (n); John Morley, MD1 (n);
Sarah Perry, MD2 (n); Hans-Christoph Pape, MD2 (n);
1Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, United Kingdom;
2University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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 intramedullary cavity causes increased liberation of these autocoids.
Methods: Consecutive adult patients with femoral shaft fractures forming two groups (a group who received unreamed nail [n = 10] and a second group who received reamed nail [n = 10]) were recruited for this study. Peripheral blood samples and samples from the femoral canal before and after reaming and before and after the solid nail insertion were collected. 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 1 (IGF-1), transforming growth factor beta 1 (TGF-β1) and bone morphogenetic 2 (BMP-2) levels was measured.
Results: In total, 20 patients were studied. The mean age was 38 years (range, 20-63). Reaming substantially increased all studied growth factors locally in the femoral canal. VEGF and PDGF were increased after reaming by 111.2% and 115.6%, respectively. IGF-1 was increased by 31.5% and TGF-β1 was increased by 54.2%. In the unreamed group, the levels of PDGF-BB, VEGF, and TGF-β1 were not changed, while the levels of IGF-1 were decreased by 10%. The levels of these factors in peripheral circulation were not altered despite the technique used. BMP-2 levels during all time points were below the detection limit of the immunoassay.
Conclusion and Significance: This study indicates that reaming of intramedullary canal is associated with increased liberation of growth factors. The osteogenic effect of reaming could be secondary not only to grafting debris but also to the increased liberation of these molecules.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.