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P28 Is Fetuin-A serum concentration a predictor of long-term outcome after proximal femur fracture in osteoporotic patients?
Osteosynthese International 2016 / Injury, Int. J. Care Injured 47S5 (2016) S1–S38
ethanol in fatal injuries cohort is lacking. The aim of this study was to investigate the correlation between alcohol and features of the fatal injuries in South Marmara region, Turkey, in the period of 2013 to 2015. Method: Historical cohort of 4535 autopsy cases performed at Bursa Morgue Department of Forensic Medicine Institute between January 1, 2013 and December 31, 2015. We detected alcohol in 490 cases, 175 of those were excluded from the study because of nontraumatic reason of death and decomposition. Age, gender, Blood Alcohol Concentration (BAC), disposition and the mechanism of death were investigated. BAC was divided into 5 groups by 100 mg/ dL intervals. Results: Age of included cases were ranging between 14 and 83 years. Only 20 of all cases were female (6.3%), 295 were male (93.7%). Alcohol related traumatic deaths were seen most frequently between the ages 40–49 (23.8%) and in summer. Traffic accidents (26%) were the most common cause of alcohol related traumatic deaths. The differences was statistically significant in the mechanisms of death between the age groups ( p Conclusion: Alcohol involved fatal injuries are 6.9% of all deaths. Injury prevention strategies and education directed at reducing alcohol involvement in injuries can contribute to the reduction of alcohol related traumatic deaths. P28 Is Fetuin-A serum concentration a predictor of long-term outcome after proximal femur fracture in osteoporotic patients? P. Herlyn1, C. Steffen1, N. Cornelius1, T. Mittlmeier1, D.-C. Fischer2. 1 Universitätsmedizin Rostock, Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Rostock, Germany, 2Universitätsmedizin, Kinder- und Jugendklinik, Rostock, Germany Question: Fractures of the proximal femur are associated with high postoperative mortality and subsequently reduced physical function. Fetuin-A is a multifunctional protein that acts as an inhibitor of ectopic calcification while favoring mineralization of bone. Epidemiological studies in elderly women showed an association between Fetuin-A serum levels and BMD. In this retrospective follow-up study we investigated the relation between Fetuin-A serum concentrations and long-term outcome after fractures of the proximal femur. Methods: Recently, we analysed bone microarchitecture and kinetics of Fetuin-A at time of fracture (t0) and during postoperative recovery (t1 and t2) in osteoporotic patients presenting with low energy fracture of the proximal femur [J Clin Densitom 2014]. Approximately 2 years later we re-examined this patient cohort with respect to Fetuin-A serum levels, anthropometric and clinical characteristics, i.e. Harris Hip Score and Merle d’Aubigné and Postel Score, Timed up and go test, Chair rising test, Tandem-stand test and handgrip strength were determined. A trauma centered History of disease including fractures and falls was derived from chart review and interview. A summary score (“overall outcome”) was developed and a Principal Components Analysis enabled us to summarize physical performance as one variable. Results and Conclusion: From the patients enrolled previously, 58 (15m/43f; (78.8±11.3 years) were still alive and 46 (14m/32f; 80.2± 11.7 years) consented to participate. Both of the newly defined variables, i.e. overall outcome and physical performance were positively associated with perioperative serum concentrations of Fetuin-A (t2: r = 0.55 and r = 0.54 respectively, each p < 0.01). Multiple linear regression analysis revealed Fetuin-A serum concentration at t1 and t2 as independent predictors of physical performance. Thus we conclude that perioperative Fetuin-A serum concentrations may serve as predictor of functional outcome in patients with low energy fractures of the proximal femur.
S35
P29 MMP-8 and MMP-9 serum levels as possible early markers for remission after traumatic spinal cord injury R. Heller1, V. Daniel1, T. Swing1, M. Akbar1, H. J. Gerner1, B. Biglari2, A. Moghaddam-Alvandi1. 1Universitätsklinikum Heidelberg, Heidelberg, Germany, 2BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany Matrix metalloproteins play a crucial role in the secondary phase of injury after traumatic spinal cord injury (SCI) and therefore have a large impact on neurological remission. We investigated serum cytokine levels as predictive markers. Between 2010 and 2015, datasets from 115 patients (33 female, 82 male) after traumatic SCI were recorded at the BG Trauma Centre Ludwigshafen. We examined the serum levels of MMP-2, MMP-8, MMP-9, MMP-10 and MMP-12 over a 12-week period, i.e., at admission (on average less than two hours after trauma) and 4, 9, 12 hours, 1 and 3 days and 1, 2, 4, 8, 12 weeks after trauma. Following the same match-pair procedure as in our previous studies, we selected 10 patients with SCI and neurological remission (Group 1) and 10 patients with an initial American Spinal Injury Association (ASIA) A grade and no neurological remission (Group 0). Ten patients with an isolated vertebral fracture without neurological deficits served as a control group (Group C). Our analysis was performed using a Luminex Performance Human High Sensitivity Cytokine Panel. SCI was classified using the ASIA Impairment Scale (AIS) at time of admission and after 12 weeks. Multivariate logistic regression models adjusting for clinically relevant covariates were used to examine the predictive value of MMP with respect to neurological remission vs. no neurological remission. MMP-8 and MMP-9 provided significantly different values for neurological remission and no neurological remission. The favoured predictive model allows to differentiate between neurological remission and no neurological remission in 97% of cases. The results indicate that further studies with an enlarged collective might be warranted in order to investigate current monitoring, prognostic and tracking techniques as well as scoring systems.
Invited lectures IL03 Proximal femur fractures A. Steindl1. 1Universitätsklinikum St. Pölten, St. Pölten, Austria Proximal femur fractures are seen globally and are a serious concern at the individual and population level. All populations experience hip fractures but numbers vary with race, gender, and age. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. Women suffer three times as many hip fractures as men. In a lifetime, men have an estimated 6% risk whereas postmenopausal women have an estimated 14% risk of suffering a hip fracture. By 2050 it is estimated that there will be 6 million cases of hip fractures worldwide. The average age for suffering a hip fracture is 77 years old for women and 72 years old for men. The rate of one year mortality is seen from 12–37% – up to a third will die within a year of the hip fracture! One study found that in 2011, femur neck fractures were among the most expensive conditions seen in US hospitals. These facts require from science and medical care continuous improvement of methods and techniques in fracture treatment in this cases. The first purpose has to prevent the incurrence of fracture – a very important disorder concerning this type of fracture is the treatment of osteoporosis of elderly person. There are developed many different methods to treat this fracture type surgically – depending on fracture localization and fracture type.
ethanol in fatal injuries cohort is lacking. The aim of this study was to investigate the correlation between alcohol and features of the fatal injuries in South Marmara region, Turkey, in the period of 2013 to 2015. Method: Historical cohort of 4535 autopsy cases performed at Bursa Morgue Department of Forensic Medicine Institute between January 1, 2013 and December 31, 2015. We detected alcohol in 490 cases, 175 of those were excluded from the study because of nontraumatic reason of death and decomposition. Age, gender, Blood Alcohol Concentration (BAC), disposition and the mechanism of death were investigated. BAC was divided into 5 groups by 100 mg/ dL intervals. Results: Age of included cases were ranging between 14 and 83 years. Only 20 of all cases were female (6.3%), 295 were male (93.7%). Alcohol related traumatic deaths were seen most frequently between the ages 40–49 (23.8%) and in summer. Traffic accidents (26%) were the most common cause of alcohol related traumatic deaths. The differences was statistically significant in the mechanisms of death between the age groups ( p Conclusion: Alcohol involved fatal injuries are 6.9% of all deaths. Injury prevention strategies and education directed at reducing alcohol involvement in injuries can contribute to the reduction of alcohol related traumatic deaths. P28 Is Fetuin-A serum concentration a predictor of long-term outcome after proximal femur fracture in osteoporotic patients? P. Herlyn1, C. Steffen1, N. Cornelius1, T. Mittlmeier1, D.-C. Fischer2. 1 Universitätsmedizin Rostock, Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Rostock, Germany, 2Universitätsmedizin, Kinder- und Jugendklinik, Rostock, Germany Question: Fractures of the proximal femur are associated with high postoperative mortality and subsequently reduced physical function. Fetuin-A is a multifunctional protein that acts as an inhibitor of ectopic calcification while favoring mineralization of bone. Epidemiological studies in elderly women showed an association between Fetuin-A serum levels and BMD. In this retrospective follow-up study we investigated the relation between Fetuin-A serum concentrations and long-term outcome after fractures of the proximal femur. Methods: Recently, we analysed bone microarchitecture and kinetics of Fetuin-A at time of fracture (t0) and during postoperative recovery (t1 and t2) in osteoporotic patients presenting with low energy fracture of the proximal femur [J Clin Densitom 2014]. Approximately 2 years later we re-examined this patient cohort with respect to Fetuin-A serum levels, anthropometric and clinical characteristics, i.e. Harris Hip Score and Merle d’Aubigné and Postel Score, Timed up and go test, Chair rising test, Tandem-stand test and handgrip strength were determined. A trauma centered History of disease including fractures and falls was derived from chart review and interview. A summary score (“overall outcome”) was developed and a Principal Components Analysis enabled us to summarize physical performance as one variable. Results and Conclusion: From the patients enrolled previously, 58 (15m/43f; (78.8±11.3 years) were still alive and 46 (14m/32f; 80.2± 11.7 years) consented to participate. Both of the newly defined variables, i.e. overall outcome and physical performance were positively associated with perioperative serum concentrations of Fetuin-A (t2: r = 0.55 and r = 0.54 respectively, each p < 0.01). Multiple linear regression analysis revealed Fetuin-A serum concentration at t1 and t2 as independent predictors of physical performance. Thus we conclude that perioperative Fetuin-A serum concentrations may serve as predictor of functional outcome in patients with low energy fractures of the proximal femur.
S35
P29 MMP-8 and MMP-9 serum levels as possible early markers for remission after traumatic spinal cord injury R. Heller1, V. Daniel1, T. Swing1, M. Akbar1, H. J. Gerner1, B. Biglari2, A. Moghaddam-Alvandi1. 1Universitätsklinikum Heidelberg, Heidelberg, Germany, 2BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany Matrix metalloproteins play a crucial role in the secondary phase of injury after traumatic spinal cord injury (SCI) and therefore have a large impact on neurological remission. We investigated serum cytokine levels as predictive markers. Between 2010 and 2015, datasets from 115 patients (33 female, 82 male) after traumatic SCI were recorded at the BG Trauma Centre Ludwigshafen. We examined the serum levels of MMP-2, MMP-8, MMP-9, MMP-10 and MMP-12 over a 12-week period, i.e., at admission (on average less than two hours after trauma) and 4, 9, 12 hours, 1 and 3 days and 1, 2, 4, 8, 12 weeks after trauma. Following the same match-pair procedure as in our previous studies, we selected 10 patients with SCI and neurological remission (Group 1) and 10 patients with an initial American Spinal Injury Association (ASIA) A grade and no neurological remission (Group 0). Ten patients with an isolated vertebral fracture without neurological deficits served as a control group (Group C). Our analysis was performed using a Luminex Performance Human High Sensitivity Cytokine Panel. SCI was classified using the ASIA Impairment Scale (AIS) at time of admission and after 12 weeks. Multivariate logistic regression models adjusting for clinically relevant covariates were used to examine the predictive value of MMP with respect to neurological remission vs. no neurological remission. MMP-8 and MMP-9 provided significantly different values for neurological remission and no neurological remission. The favoured predictive model allows to differentiate between neurological remission and no neurological remission in 97% of cases. The results indicate that further studies with an enlarged collective might be warranted in order to investigate current monitoring, prognostic and tracking techniques as well as scoring systems.
Invited lectures IL03 Proximal femur fractures A. Steindl1. 1Universitätsklinikum St. Pölten, St. Pölten, Austria Proximal femur fractures are seen globally and are a serious concern at the individual and population level. All populations experience hip fractures but numbers vary with race, gender, and age. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. Women suffer three times as many hip fractures as men. In a lifetime, men have an estimated 6% risk whereas postmenopausal women have an estimated 14% risk of suffering a hip fracture. By 2050 it is estimated that there will be 6 million cases of hip fractures worldwide. The average age for suffering a hip fracture is 77 years old for women and 72 years old for men. The rate of one year mortality is seen from 12–37% – up to a third will die within a year of the hip fracture! One study found that in 2011, femur neck fractures were among the most expensive conditions seen in US hospitals. These facts require from science and medical care continuous improvement of methods and techniques in fracture treatment in this cases. The first purpose has to prevent the incurrence of fracture – a very important disorder concerning this type of fracture is the treatment of osteoporosis of elderly person. There are developed many different methods to treat this fracture type surgically – depending on fracture localization and fracture type.