Journal article
Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair
Journal of orthopaedic trauma, Vol.36, pp.S32-S39
02/2022
DOI: 10.1097/BOT.0000000000002307
PMCID: PMC10308601
PMID: 35061649
Abstract
Objectives:To use a novel, validated bioassay to monitor serum concentrations of a breakdown product of collagen X in a prospective longitudinal study of patients sustaining isolated tibial plateau fractures. Collagen X is the hallmark extracellular matrix protein present during conversion of soft, cartilaginous callus to bone during endochondral repair. Previous preclinical and clinical studies demonstrated a distinct peak in collagen X biomarker (CXM) bioassay levels after long bone fractures.Setting:Level 1 academic trauma facility.Patients/Participants:Thirty-six patients; isolated tibial plateau fractures.Intervention:(3) Closed treatment, ex-fix (temporizing/definitive), and open reduction internal fixation.Main Outcome Measurements:Collagen X serum biomarker levels (CXM bioassay).Results:Twenty-two men and 14 women (average age: 46.3 y; 22.6-73.4, SD 13.3) enrolled (16 unicondylar and 20 bicondylar fractures). Twenty-five patients (72.2%) were treated operatively, including 12 (33.3%) provisionally or definitively treated by ex-fix. No difference was found in peak CXM values between sexes or age. Patients demonstrated peak expression near 1000 pg/mL (average: male-986.5 pg/mL, SD 369; female-953.2 pg/mL, SD 576). There was no difference in peak CXM by treatment protocol, external fixator use, or fracture severity (Schatzker). Patients treated with external fixation (P = 0.05) or staged open reduction internal fixation (P = 0.046) critically demonstrated delayed peaks.Conclusions:Pilot analysis demonstrates a strong CXM peak after fractures commensurate with previous preclinical and clinical studies, which was delayed with staged fixation. This may represent the consequence of delayed construct loading. Further validation requires larger cohorts and long-term follow-up. Collagen X may provide an opportunity to support prospective interventional studies testing novel orthobiologics or fixation techniques.Level of Evidence:Level II, prospective clinical observational study.
Details
- Title: Subtitle
- Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair
- Creators
- Zachary M. Working - Oregon Health & Science UniversityDanielle Peterson - Oregon Health & Science UniversityMichelle Lawson - Oregon Health & Science UniversityKelsey O'Hara - Steadman Philippon Research InstituteRyan Coghlan - Shriners Hospitals for Children - PortlandMatthew T. Provencher - Steadman Philippon Research InstituteDarin M. Friess - Oregon Health & Science UniversityBrian Johnstone - Oregon Health & Science UniversityTheodore Miclau - Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California at San Francisco, San Francisco, CAChelsea S. Bahney - Steadman Philippon Research Institute
- Resource Type
- Journal article
- Publication Details
- Journal of orthopaedic trauma, Vol.36, pp.S32-S39
- DOI
- 10.1097/BOT.0000000000002307
- PMID
- 35061649
- PMCID
- PMC10308601
- NLM abbreviation
- J Orthop Trauma
- ISSN
- 0890-5339
- eISSN
- 1531-2291
- Publisher
- Journal of Orthopaedic Trauma; PHILADELPHIA
- Grant note
- AO Trauma North AmericaOrthopaedic Research and Education FoundationGerlinger FoundationUCSF New Orthopaedic Vision AwardDonna Giordano
This research was funded by grants from AO Trauma North America, Orthopaedic Research and Education Foundation, the Gerlinger Foundation, the UCSF New Orthopaedic Vision Award, and a philanthropic gift from Donna Giordano.
- Language
- English
- Date published
- 02/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984949468102771
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