Acute Limb Ischemia and Reperfusion Impairs rhBMP-2 Mediated Fracture Healing

Abstract : Extremity fractures due to high energy trauma are primarily open (i.e. Gustillo Type II/III) with indications of severe soft tissue damage(i.e. volumetric muscle loss (VML)). Further compounding these complex injuries is the potential for the presence of vascular trauma resulting in acute limbischemia followed by reperfusion injury. Among the wounded warrior population from the conflict in Afghanistan, approximately half of the patientspresenting vascular injury concomitant to bone and muscle loss were reparable via surgical intervention, resulting in a condition of bone and muscle losscompounded by transient ischemia (i.e. ischemia-reperfusion (I/R)). Recent data has shown a strong interaction between the viability of the surrounding softtissue and the ability of bone to heal. While this emerging research field has defined the broad associations present between bone and the musculature andvasculature independently, the potential compounding effects of these morbidities have not yet been elucidated. The aim of this study was to investigateinteractions between these comorbities to fracture and the roles they may play in delayed and non-unions.