[Damage control orthopedics].

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Abstract

[Indexed for MEDLINE] 8. Bone Joint Res. 2024 May 3;13(5):214-225. doi: 10.1302/2046-3758.135.BJR-2023-0323.R1. Fracture haematoma proteomics. Groven RVM(1)(2), Kuik C(3), Greven J(4), Mert Ü(5), Bouwman FG(6), Poeze M(2), Blokhuis TJ(2), Huber-Lang M(7), Hildebrand F(5), Cillero-Pastor B(1)(3), van Griensven M(1). Author information: (1)Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands. (2)Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands. (3)Maastricht Multimodal Molecular Imaging (M4i) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, Netherlands. (4)Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany. (5)Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany. (6)NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands. (7)Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany. AIMS: The aim of this study was to determine the fracture haematoma (fxH) proteome after multiple trauma using label-free proteomics, comparing two different fracture treatment strategies. METHODS: A porcine multiple trauma model was used in which two fracture treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). fxH was harvested and analyzed using liquid chromatography-tandem mass spectrometry. Per group, discriminating proteins were identified and protein interaction analyses were performed to further elucidate key biomolecular pathways in the early fracture healing phase. RESULTS: The early fxH proteome was characterized by immunomodulatory and osteogenic proteins, and proteins involved in the coagulation cascade. Treatment-specific proteome alterations were observed. The fxH proteome of the ETC group showed increased expression of pro-inflammatory proteins related to, among others, activation of the complement system, neutrophil functioning, and macrophage activation, while showing decreased expression of proteins related to osteogenesis and tissue remodelling. Conversely, the fxH proteome of the DCO group contained various upregulated or exclusively detected proteins related to tissue regeneration and remodelling, and proteins related to anti-inflammatory and osteogenic processes. CONCLUSION: The early fxH proteome of the ETC group was characterized by the expression of immunomodulatory, mainly pro-inflammatory, proteins, whereas the early fxH proteome of the DCO group was more regenerative and osteogenic in nature. These findings match clinical observations, in which enhanced surgical trauma after multiple trauma causes dysbalanced inflammation, potentially leading to reduced tissue regeneration, and gained insights into regulatory mechanisms of fracture healing after severe trauma. © 2024 Groven et al. DOI: 10.1302/2046-3758.135.BJR-2023-0323.R1 PMCID: PMC11090216