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Time dependent loss of trabecular bone in human tibial plateau fractures
Author(s) -
Solomon Lucian B.,
Kitchen David,
Anderson Paul H.,
Yang Dongqing,
Starczak Yolandi,
Kogawa Masakazu,
Perilli Egon,
Smitham Peter J.,
Rickman Mark S.,
Thewlis Dominic,
Atkins Gerald J.
Publication year - 2018
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24057
Subject(s) - medicine , bone resorption , cancellous bone , tibia , resorption , bone healing , rankl , urology , surgery , pathology , receptor , activator (genetics)
We investigated if time between injury and surgery affects cancellous bone properties in patients suffering tibial plateau fractures (TPF), in terms of structural integrity and gene expression controlling bone loss. A cohort of 29 TPF, operated 1–17 days post‐injury, had biopsies from the fracture and an equivalent contralateral limb site, at surgery. Samples were assessed using micro‐computed tomography and real‐time RT‐PCR analysis for the expression of genes known to be involved in bone remodeling and fracture healing. Significant decreases in the injured vs control side were observed for bone volume fraction (BV/TV, −13.5 ± 6.0%, p = 0.011), trabecular number (Tb.N, −10.5 ± 5.9%, p = 0.041) and trabecular thickness (Tb.Th, −4.6 ± 2.5%, p = 0.033). Changes in these parameters were more evident in patients operated 5–17 days post‐injury, compared to those operated in the first 4 days post‐injury. A significant negative association was found between Tb.Th ( r = −0.54, p < 0.01) and BV/TV ( r = −0.39, p < 0.05) in relation to time post‐injury in the injured limb. Both BV/TV and Tb.Th were negatively associated with expression of key molecular markers of bone resorption, CTSK , ACP5 , and the ratio of RANKL : OPG mRNA. These structure/gene expression relationships did not exist in the contralateral tibial plateau of these patients. This study demonstrated that there is a significant early time‐dependent bone loss in the proximal tibia after TPF. This bone loss was significantly associated with altered expression of genes typically involved in the process of osteoclastic bone resorption but possibly also bone resorption by osteocytes. The mechanism of early bone loss in such fractures should be a subject of further investigation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2865–2875, 2018.