{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:45:39Z","timestamp":1762868739076,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of \u226510 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.<\/jats:p>","DOI":"10.3390\/jcm11030717","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T05:26:17Z","timestamp":1643433977000},"page":"717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influence of Thoracic Trauma on Fracture Healing in Long Bones\u2014A Retrospective Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Karsten","family":"Timm","sequence":"first","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0654-2076","authenticated-orcid":false,"given":"Nike","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0858-1551","authenticated-orcid":false,"given":"Martin","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gero","family":"Knapp","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Thormann","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1187-8578","authenticated-orcid":false,"given":"Thaqif","family":"El Khassawna","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"},{"name":"Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Alt","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"},{"name":"Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Heiss","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"},{"name":"Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7221-3783","authenticated-orcid":false,"given":"Markus","family":"Rupp","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany"},{"name":"Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"186","DOI":"10.11138\/ccmbm\/2017.14.1.186","article-title":"Non-unions","volume":"14","author":"Calori","year":"2017","journal-title":"Clin Cases Miner Bone Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s00264-017-3734-5","article-title":"Diaphyseal long bone nonunions\u2014types, aetiology, economics, and treatment recommendations","volume":"42","author":"Rupp","year":"2018","journal-title":"Int. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6407098","DOI":"10.1155\/2019\/6407098","article-title":"Do Systemic Factors Influence the Fate of Nonunions to Become Atrophic? A Retrospective Analysis of 162 Cases","volume":"2019","author":"Rupp","year":"2019","journal-title":"BioMed Res. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00068-019-01079-4","article-title":"Focus on non-union of fractures","volume":"45","author":"Marzi","year":"2019","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/nrrheum.2012.1","article-title":"Fracture healing under healthy and inflammatory conditions","volume":"8","author":"Claes","year":"2012","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1302\/0301-620X.94B2.28193","article-title":"The effects of an injury to the brain on bone healing and callus formation in young adults with fractures of the femoral shaft","volume":"94","author":"Yang","year":"2012","journal-title":"J. Bone Jt. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/j.1445-2197.2008.04803.x","article-title":"Serum-mediated osteogenic effect in traumatic brain-injured patients","volume":"79","author":"Gautschi","year":"2009","journal-title":"ANZ J. Surg."},{"key":"ref_8","first-page":"738","article-title":"Osteogenic Effects of Traumatic Brain Injury on Experimental Fracture-Healing","volume":"88","author":"Boes","year":"2006","journal-title":"J. Bone Jt. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3109\/17453674.2011.570677","article-title":"The effect of both a thoracic trauma and a soft-tissue trauma on fracture healing in a rat model","volume":"82","author":"Claes","year":"2011","journal-title":"Acta Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1002\/jor.21299","article-title":"Experimental blunt chest trauma impairs fracture healing in rats","volume":"29","author":"Recknagel","year":"2011","journal-title":"J. Orthop. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1007\/s00402-017-2695-x","article-title":"The effect of a combined thoracic and soft-tissue trauma on blood flow and tissue formation in fracture healing in rats","volume":"137","author":"Claes","year":"2017","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-019-1082-4","article-title":"Burn and thoracic trauma alters fracture healing, systemic inflammation, and leukocyte kinetics in a rat model of polytrauma","volume":"14","author":"Mangum","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/TA.0b013e318278956d","article-title":"Systemic inflammation induced by a thoracic trauma alters the cellular composition of the early fracture callus","volume":"74","author":"Recknagel","year":"2013","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/jor.21561","article-title":"C5aR-antagonist significantly reduces the deleterious effect of a blunt chest trauma on fracture healing","volume":"30","author":"Recknagel","year":"2012","journal-title":"J. Orthop. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kemmler, J., Bindl, R., McCook, O., Wagner, F., Gr\u00f6ger, M., Wagner, K., Scheuerle, A., Radermacher, P., and Ignatius, A. (2015). Exposure to 100% Oxygen Abolishes the Impairment of Fracture Healing after Thoracic Trauma. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0131194"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1097\/ALN.0000000000001541","article-title":"Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients","volume":"126","author":"Hurwitz","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The Injury Severity Scor: A method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0736-4679(00)00182-7","article-title":"The Glasgow Coma Scale","volume":"19","author":"Sternbach","year":"2000","journal-title":"J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jss.2011.09.018","article-title":"Comparison of Different Thoracic Trauma Scoring Systems in Regards to Prediction of Post-Traumatic Complications and Outcome in Blunt Chest Trauma","volume":"176","author":"Mommsen","year":"2012","journal-title":"J. Surg. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1097\/00005373-200009000-00018","article-title":"Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making","volume":"49","author":"Pape","year":"2000","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1001\/jama.1971.03180150059012","article-title":"Rating the Severity of Tissue Damage","volume":"215","author":"Keller","year":"1971","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/BOT.0000000000000390","article-title":"Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures","volume":"29","author":"Litrenta","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1002\/jor.23710","article-title":"Correlation between RUST assessments of fracture healing to structural and biomechanical properties","volume":"36","author":"Cooke","year":"2017","journal-title":"J. Orthop. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3, A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1037\/0033-2909.111.2.361","article-title":"A common language effect size statistic","volume":"111","author":"McGraw","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"van der Worp, H.B., Howells, D.W., Sena, E.S., Porritt, M.J., Rewell, S., O\u2019Collins, V., and Macleod, M.R. (2010). Can Animal Models of Disease Reliably Inform Human Studies?. PLoS Med., 7.","DOI":"10.1371\/journal.pmed.1000245"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3507","DOI":"10.1073\/pnas.1222878110","article-title":"Genomic responses in mouse models poorly mimic human inflammatory diseases","volume":"110","author":"Seok","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s11914-018-0423-2","article-title":"The Role of the Immune Cells in Fracture Healing","volume":"16","author":"Baht","year":"2018","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Strobel, M.C., Reinholdt, L.G., Malcolm, R.D., and Pritchett-Corning, K. (2015). Genetic Monitoring of Laboratory Mice and Rats. Laboratory Animal Medicine, Elsevier.","DOI":"10.1016\/B978-0-12-409527-4.00031-6"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1038\/nrg.2017.89","article-title":"Prioritizing diversity in human genomics research","volume":"19","author":"Hindorff","year":"2018","journal-title":"Nat. Rev. Genet."},{"key":"ref_31","first-page":"262","article-title":"Types of Study in Medical Research","volume":"106","author":"Wachtlin","year":"2009","journal-title":"Dtsch. Aerzteblatt Online"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/17453674.2017.1321351","article-title":"The risk of non-union per fracture: Current myths and revised figures from a population of over 4 million adults","volume":"88","author":"Mills","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S0020-1383(07)80003-9","article-title":"Prevalence of long-bone non-unions","volume":"38","author":"Tzioupis","year":"2007","journal-title":"Injury"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00068-018-0905-z","article-title":"Diagnosis and management of long-bone nonunions: A nationwide survey","volume":"45","author":"Nolte","year":"2019","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/BOT.0000000000001190","article-title":"Comparing Radiographic Progression of Bone Healing in Gustilo IIIB Open Tibia Fractures Treated with Muscle Versus Fasciocutaneous Flaps","volume":"32","author":"Mehta","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"533","DOI":"10.3944\/AOTT.2014.14.0026","article-title":"Reliability of the Radiographic Union Score for Tibial Fractures","volume":"48","author":"Cekic","year":"2014","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_37","first-page":"35","article-title":"Reliability of the radiographic union scale in tibial fractures (RUST)","volume":"52","author":"Azevedo","year":"2017","journal-title":"Rev. Bras. Ortop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1302\/0301-620X.94B4.27927","article-title":"Validation of a standardised gait score to predict the healing of tibial fractures","volume":"94","author":"Macri","year":"2012","journal-title":"J. Bone Jt. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.2106\/JBJS.E.00381","article-title":"Recombinant Human BMP-2 and Allograft Compared with Autogenous Bone Graft for Reconstruction of Diaphyseal Tibial Fractures with Cortical Defects","volume":"88","author":"Jones","year":"2006","journal-title":"J. Bone Jt. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/00005131-200209000-00004","article-title":"A Lack of Consensus in the Assessment of Fracture Healing Among Orthopaedic Surgeons","volume":"16","author":"Bhandari","year":"2002","journal-title":"J. Orthop. Trauma"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1097\/BOT.0000000000000470","article-title":"Assessment of Fracture Repair","volume":"29","author":"Cook","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13049-017-0384-y","article-title":"Lessons from a large trauma center: Impact of blunt chest trauma in polytrauma patients\u2014still a relevant problem?","volume":"25","author":"Chrysou","year":"2017","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1097\/00005373-199905000-00011","article-title":"Pulmonary Contusions","volume":"46","author":"Tyburski","year":"1999","journal-title":"J. Trauma: Inj. Infect. Crit. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.annemergmed.2014.03.025","article-title":"Looking Through the Retrospectoscope: Reducing Bias in Emergency Medicine Chart Review Studies","volume":"64","author":"Kaji","year":"2014","journal-title":"Ann. Emerg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s00223-017-0293-0","article-title":"Mechanical Stress by Spasticity Accelerates Fracture Healing After Spinal Cord Injury","volume":"101","author":"Sakitani","year":"2017","journal-title":"Calcif Tissue Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.thorsurg.2017.01.004","article-title":"Chest Wall Trauma","volume":"27","author":"Majercik","year":"2017","journal-title":"Thorac. Surg. Clin."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"133","DOI":"10.21873\/invivo.11449","article-title":"Limited Influence of Flail Chest in Patients with Blunt Thoracic Trauma\u2013A Matched-pair Analysis","volume":"33","author":"Getz","year":"2019","journal-title":"In Vivo"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:10:28Z","timestamp":1760134228000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,28]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030717"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030717","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,1,28]]}}}