Citation

Sears BW, Volkmer D, Yong S, Himes RD, Lauing K, Morgan M, Stover MD, Callaci JJ. J. Bone Joint Surg. Am. 2011; 93(8): 739-749.

Affiliation

Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153. bwsears@gmail.com.

Copyright

(Copyright © 2011, Journal of Bone and Joint Surgery)

DOI

10.2106/JBJS.J.00318

PMID

21508281

PMCID

PMC3073017

Abstract

BACKGROUND: Alcohol is a known modulator of the immune system and host-defense response. Alcohol abuse is common in trauma patients, although the influence of alcohol intoxication on the inflammatory response following major orthopaedic injury remains unknown. The aim of this investigation was to examine the influence of binge alcohol exposure on biomarkers of the systemic inflammatory response following bilateral traumatic femoral fracture in a rodent model. METHODS: Ninety-two Sprague-Dawley rats were administered intraperitoneal injections of either saline solution or alcohol for three days. These animals then underwent a sham procedure or bilateral femoral intramedullary pinning and mid-diaphyseal closed fracture via blunt guillotine. The animals were killed at specific time points after the injury. Serum and lung tissue were collected, and twenty-five inflammatory markers were analyzed by immunoassay. Histological sections of lung tissue were evaluated by a board-certified pathologist. RESULTS: Bilateral femoral fracture significantly (p < 0.05) increased multiple serum biomarkers of inflammation. Binge alcohol treatment prior to injury significantly suppressed the increase in serum levels of interleukin (IL)-6, white blood cells, IL-2, IL-10, and C-reactive protein after the fracture. However, alcohol-treated animals were found to have increased pulmonary levels of IL-6, IL-1β, IL-2, and macrophage inflammatory protein-1α following bilateral femoral fracture. In addition, lung tissue harvested following alcohol treatment and injury demonstrated increased pathologic changes, including parenchymal, alveolar, and peribronchial leukocyte infiltration and significantly elevated pulmonary wet-to-dry ratio, indicative of pulmonary edema. CONCLUSIONS: Our results indicate that acute alcohol intake prior to bilateral femoral fracture with fixation in rats modulates the inflammatory response after injury in a tissue-dependent manner. Although serum biomarkers of inflammation were suppressed in alcohol-treated animals following injury, several measures of pulmonary inflammation including cytokine levels, histological changes, and findings of pulmonary edema were significantly increased following fracture with the presence of alcohol. CLINICAL RELEVANCE: These findings indicate that alcohol modulates the inflammatory response after a major orthopaedic injury and that analysis of serum markers of inflammation after trauma may not represent the pulmonary inflammatory status in acutely intoxicated patients.

Language: en