Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma
Aims: Polytraumatized patients with severe limb injuries often develop complications, which are influenced by the surgical treatment strategy. For the initial fracture stabilization, Early Total Care (ETC) and Damage Control Orthopedics (DCO) are competing concepts, with the treatment choice dependi...
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The British Editorial Society of Bone & Joint Surgery
2025-07-01
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| Series: | Bone & Joint Research |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.147.BJR-2024-0364.R1 |
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| author | Changlin Qi Nils Becker Nan Zhou Diana Möckel Twan Lammers Rebecca Halbgebauer Johannes Greven Maximilian Praster Frank Hildebrand Klemens Horst Elizabeth R. Balmayor |
| author_facet | Changlin Qi Nils Becker Nan Zhou Diana Möckel Twan Lammers Rebecca Halbgebauer Johannes Greven Maximilian Praster Frank Hildebrand Klemens Horst Elizabeth R. Balmayor |
| author_sort | Changlin Qi |
| collection | DOAJ |
| description | Aims: Polytraumatized patients with severe limb injuries often develop complications, which are influenced by the surgical treatment strategy. For the initial fracture stabilization, Early Total Care (ETC) and Damage Control Orthopedics (DCO) are competing concepts, with the treatment choice depending on the patient’s condition. Clear guidance factors remain lacking. Our study aimed to compare the effects of ETC and DCO strategies on fracture healing and functional gait behaviour in a rat multiple-trauma model. Methods: A standardized rat multiple-trauma model was established, which included haemorrhagic shock, blunt chest trauma, and a femur fracture with subsequent reduction and fixation by group-specific operative strategies. Adult Sprague-Dawley male rats (n = 45) were randomly allocated to three groups: Sham (n = 9), ETC (primary intramedullary nailing (IN); n = 18), and DCO-IN (external fixation with conversion to IN at day 6 after the trauma; n = 18). Postoperative gait changes at different timepoints were analyzed using the CatWalk system. At seven, 21, and 42 days, the animals were euthanized to assess bone formation of the femur fracture histologically and via micro-CT. Biomechanical stability was assessed by a three-point bending test. Results: Fixation conversion surgery in the DCO-IN group decreased callus formation, resulting in delayed fracture healing with reduced callus quality and poorer biomechanical properties compared to the ETC group. The DCO-IN group also exhibited poorer weightbearing and locomotor-function rehabilitation compared to the ETC group, consistent with the impaired fracture healing process. Conclusion: These results demonstrate that conversion of the fixation method in the DCO strategy delays the callus formation process up to six weeks after trauma, potentially contributing to delayed rehabilitation and higher risk of nonunion in multiple-trauma patients. DCO should be limited to patients with contraindications for ETC, underlining the need for clear identification factors. Cite this article: Bone Joint Res 2025;14(7):619–632. |
| format | Article |
| id | doaj-art-0a7e807f09934da881267bc8f1e2ce67 |
| institution | Kabale University |
| issn | 2046-3758 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj-art-0a7e807f09934da881267bc8f1e2ce672025-08-20T03:58:49ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582025-07-0114761963210.1302/2046-3758.147.BJR-2024-0364.R1Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple traumaChanglin Qi0Nils Becker1Nan Zhou2Diana Möckel3Twan Lammers4Rebecca Halbgebauer5Johannes Greven6Maximilian Praster7Frank Hildebrand8Klemens Horst9Elizabeth R. Balmayor10Experimental Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, GermanyExperimental Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, GermanyDepartment of Nanomedicine and Theragnostic, Institute for Experimental Molecular Imaging (ExMI), RWTH Aachen University Hospital, Aachen, GermanyDepartment of Nanomedicine and Theragnostic, Institute for Experimental Molecular Imaging (ExMI), RWTH Aachen University Hospital, Aachen, GermanyInstitute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, GermanyExperimental Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, GermanyExperimental Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, GermanyExperimental Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, GermanyAims: Polytraumatized patients with severe limb injuries often develop complications, which are influenced by the surgical treatment strategy. For the initial fracture stabilization, Early Total Care (ETC) and Damage Control Orthopedics (DCO) are competing concepts, with the treatment choice depending on the patient’s condition. Clear guidance factors remain lacking. Our study aimed to compare the effects of ETC and DCO strategies on fracture healing and functional gait behaviour in a rat multiple-trauma model. Methods: A standardized rat multiple-trauma model was established, which included haemorrhagic shock, blunt chest trauma, and a femur fracture with subsequent reduction and fixation by group-specific operative strategies. Adult Sprague-Dawley male rats (n = 45) were randomly allocated to three groups: Sham (n = 9), ETC (primary intramedullary nailing (IN); n = 18), and DCO-IN (external fixation with conversion to IN at day 6 after the trauma; n = 18). Postoperative gait changes at different timepoints were analyzed using the CatWalk system. At seven, 21, and 42 days, the animals were euthanized to assess bone formation of the femur fracture histologically and via micro-CT. Biomechanical stability was assessed by a three-point bending test. Results: Fixation conversion surgery in the DCO-IN group decreased callus formation, resulting in delayed fracture healing with reduced callus quality and poorer biomechanical properties compared to the ETC group. The DCO-IN group also exhibited poorer weightbearing and locomotor-function rehabilitation compared to the ETC group, consistent with the impaired fracture healing process. Conclusion: These results demonstrate that conversion of the fixation method in the DCO strategy delays the callus formation process up to six weeks after trauma, potentially contributing to delayed rehabilitation and higher risk of nonunion in multiple-trauma patients. DCO should be limited to patients with contraindications for ETC, underlining the need for clear identification factors. Cite this article: Bone Joint Res 2025;14(7):619–632.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.147.BJR-2024-0364.R1multiple-traumasurgical treatment strategyearly total caredamage control orthopaedicsbone callusfracture healingtraumarat modelfractured femoramicro-ct scanningsurgical approachesfracture stabilizationcallus formationexternal fixationnonunions |
| spellingShingle | Changlin Qi Nils Becker Nan Zhou Diana Möckel Twan Lammers Rebecca Halbgebauer Johannes Greven Maximilian Praster Frank Hildebrand Klemens Horst Elizabeth R. Balmayor Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma Bone & Joint Research multiple-trauma surgical treatment strategy early total care damage control orthopaedics bone callus fracture healing trauma rat model fractured femora micro-ct scanning surgical approaches fracture stabilization callus formation external fixation nonunions |
| title | Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| title_full | Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| title_fullStr | Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| title_full_unstemmed | Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| title_short | Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| title_sort | damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma |
| topic | multiple-trauma surgical treatment strategy early total care damage control orthopaedics bone callus fracture healing trauma rat model fractured femora micro-ct scanning surgical approaches fracture stabilization callus formation external fixation nonunions |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.147.BJR-2024-0364.R1 |
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