pain-management-2016_posters-accepted-abstracts

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Pain Management 2016

October 03-04, 2016

Volume 5, Issue 5(Suppl)

J Pain Relief

ISSN: 2167-0846 JPAR, an open access journal

conferenceseries

.com

October 03-04, 2016 Vancouver, Canada

International Conference on

Pain Research & Management

J Pain Relief 2016, 5:5(Suppl)

Bone healing, hormonal bioassay and growth factors measurement in patients with long bone

fractures and concomitant acute traumatic spinal cord injuries

Fathy G Khallaf

Mubarak Al Kabeer University Hospital-Ministry of Health, Kuwait

Aim:

The aim of the study was to test the effect of acute traumatic spinal cord injury of quadriplegia or paraplegia on bone

healing in patients with associated long bone fractures and to investigate the molecular and cellular events of the underlying

mechanism for a possible acceleration.

Methods:

Bone healing indicators of long bone fractures, hormonal bioassay for parathyroid hormone, growth hormone,

corticosteroids, noradrenaline, adrenaline, leptin hormone, and growth factors measurement for Insulin like growth factor

II (IGF-II), platelet- derived growth factor (PDGF), vascular endothelial growth factor (VEGF), Activin-A, and cytokine

Interleukin I ( I-L-1), in the patients' blood were calculated for 21 patients with spinal cord injuries and associated long bone

fractures (Group B) in prospective controlled study and compared to 20 patients with only spinal cord injuries (Group A), and

30 patients with only long bone fractures (Group C).

Results:

The study results showed that the mean time of bone union in group B was 6.3, range (3.7-7.5) weeks. There were no

cases of non-union of long bones in this group. The mean maximal thickness of union bridging callus as shown in CT scan

was 29, range (10-48) mm. The mean healing rate was 4.7, range (2.6-7.5) mm/week, versus 6 (16.7%) went into atrophic non-

union, with the mean healing time 22.5, range (14-42) weeks, the mean maximal thickness of union callus 8, range (2-20) mm,

and the mean healing rate 0.41, range (0.25-1) mm/week in group C. The study showed statistically higher levels of parathyroid

hormone and growth hormone (p<0.005) and normal corticosteroids levels. Patients with long bone fractures only showed

consistent and statistically significant higher level of noradrenaline and adrenaline hormones compared to patients with spinal

cord injury alone or associated with long bone fractures (p<0.001). Leptin hormone showed statistically significant consistent

decrease in patients with spinal cord injury and concomitant long bone fractures compared to healthy subjects (p<0.001). It

also showed statistically significant higher levels of growth factors like PDGF, VEGF, Activin-A, and cytokine I-L-1, along the

3 weeks of follow-up (P>0.005). I-IGF-II showed statistically significant subnormal level along the whole follow-up period in

the same patients (P>0.005).

Conclusions:

We concluded that long bone fractures in spinal cord injury patients heal more expectedly, faster, and with

exuberant and florid callus formation. We can also conclude that bone healing has a central neuronal regulation and a combined

neuro- hormonal mechanism with inhibition of the sympathetic nervous system is a possible cause of accelerated healing of

long bone fractures in patients with associated spinal cord injury and growth factors like IGF-II, PDGF, VEGF, Activin-A, and

cytokine I-L-I have roles as mediators, in molecular events and as byproducts of the aforementioned mechanism.