F61IMPROVEO FRACTURE HEALING IN SEVERELY TRAUMATIZED RATS TREATED WITH TOTAL PARENTERAL NUTRITION (TPN). C.W.Heard, R.B.Griffith, T.K.Smith, J.M.Daly, S.J.Dudrick.Dept.of Surg., St.Luke's Episcopal Hospital and the Univ. of Texas, Houston, Texas, USA. Severely injured rats were studied in order to determine the effects of nutritional status and therapy on fracture healing. Initially, an animal trauma model was developed which was comparable in metabolic response to that observed in humans with long bone fractures. This pilot study showed that 250-300 gm male Sprague-Dawley rats subjected to tibia1 osteotomy and 40% 3rd dearee burn had sufficient catabolism to allow evaluation of nutritional support on fracture healing. Following this injury 47 rats received 3 different diets for 8 davs (GD 1, n=24, IV DinW; Go 2. n=12. TPN; GD 3, n=ll, oral diet). All animals received the oral?iet from day 8 to 22,' and were then sacrificed prior to evaluation of fracture healing; movement at the fracture site was graded on a 0.3 scale; callus formation was assessed on a O-4 scale; fracture strength was quantitated biomechanically with a modified Weiss-Ickowitz apparatus. Sumnary of primary data: Mortality GP I GP 2 GP 3
75% 25% 0%
Weight Day 8 -35% - 6% -0.4%
Change Day 22 - 2% t 9% +16%
Fracture Evaluation Movement X-ray Strength 0.6 1134 gm ;?3 3.3 1669 gm 1:2 1773 gm 3.2
There were no significant differences between Gp 2 and 3. However, all 6 indices in Gp 1 were statistically different from those in Gp 2 or 3 (pL. 0.001). Previous studies have documented the marked catabolism associated with long bone fractures and the impaired bone healing associated with severe hypoproteinemia in animals. This controlled study clearly demonstrates for the first time a positive correlation between the quality of nutrition therapy and the rate and quality of fracture healing. Optimal nutrition therapy appears indicated clinically if patients sustaining major long bone fractures and/or multiple trauma are to experience optimal fracture healing. Controlled clinical studies in man are indicated to confirm these data.
F62 ENERGY EXPENDITURE AND THYROID HORMONES IN POLYTRAUMATIZED PATIENTS K.-H. Altemeyer, J.-E. Schmitz, W. Seeling, U. Loos', F. W. Ahnefeld. Center of Anaesthesiology, University of Ulm. Heads: Prof. Dr. F. W. Ahnefeld, Prof. Dr. W. Dick, Dr. Dr. A. GrUnert; Center of Internal Medicine+, Head: Prof. Dr. Dr. hc Pfeiffer, Steinhovelstr. 9, D-7900 Ulm There are very few reports in the literature dealing with simultaneous measurements of energy expenditure and thyroid hormone concentrations in polytraumatized patients. It is being well known that there is a close relationship between energy metabolism and thyroid activity we investiqated enerqy expenditure of 12 severelv injured oatients bv oas exchange measurements as well as T3, reversed"T3 and T4'every day"o;er a period of 4 days. During this period the patients only received water and electrolytes. Despite the severity of injury energy expenditure was relativly low (median: 2000 kcal on the 1 day and median: 2500 kcal on the 4. day). Corresponding to these findings T3 was markedly below reference range (median: 0,5 ug/ml, reference range: 0,8 - 1,8 uq/ml, while reversed T? was significantly above reference range (0,7 pg/ml,' reference range: 0,15 z 0,35 g/ml. The medians of T4 were just within the lower reference range (median: ! $0 us/ml, reference range: 4,0 - 12,0 pg/ml). Summarizing the data we can say that in our patients energy expenditure was low in contrast to other results in the literature. One of the reasons for this finding is probably due to the low levels of active thyroid hormone.