TY - JOUR
T1 - Time dependent loss of trabecular bone in human tibial plateau fractures
AU - Solomon, Lucian
AU - Kitchen, David
AU - Anderson, Paul
AU - Yang, Dongqing
AU - Starczak, Yolandi
AU - Kogawa, Masakazu
AU - Perilli, Egon
AU - Smitham, Peter
AU - Rickman, Mark
AU - Thewlis, Dominic
AU - Atkins, Gerald
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
KW - bone remodelling
KW - gene expression
KW - micro-computed tomography
KW - tibial plateau fracture
UR - https://onlinelibrary.wiley.com/doi/abs/10.1002/jor.24057
UR - http://www.scopus.com/inward/record.url?scp=85050585470&partnerID=8YFLogxK
U2 - 10.1002/jor.24057
DO - 10.1002/jor.24057
M3 - Article
SN - 0736-0266
VL - 36
SP - 2865
EP - 2875
JO - Journal of Orthopaedic Research
JF - Journal of Orthopaedic Research
IS - 11
ER -