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Pathoanatomy and Clinical Correlates of the Immunoinflammatory Response Following Orthopaedic Trauma

Dr. Sears is Resident, Department of Orthopaedics, Loyola University Medical Center, Maywood, IL. Dr. Stover is Chief, Division of Trauma, Loyola University Medical Center. Dr. Callaci is Director, Musculoskeletal Biology Research Laboratory, Loyola University Medical Center.

Dr. Stover or a member of his immediate family serves as a board member, owner, officer, or committee member of the Association of Bone and Joint Surgeons and the Orthopaedic Trauma Association; and has received research or institutional support from Health and Human Services, and Synthes. Dr. Callaci has received research or institutional support from Medtronic. Neither Dr. Sears nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Benjamin W. Sears, MD, et al

Reprint requests: Dr. Sears, Department of Orthopaedics, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.

The natural inflammatory response to major trauma may be associated with the development of a systemic inflammatory state, remote multiorgan failure, and death. Although a controlled inflammatory response is beneficial, an exaggerated response can cause serious adverse systemic effects. Early identification of high-risk patients, based on inflammatory markers and genomic predisposition, should help direct intervention in terms of surgical stabilization and biologic response modification. Currently, two markers of immune reactivity, interleukin-6 and human leukocyte antigen–DR class II molecules, appear to have the most potential for regular use in predicting the clinical course and outcome in trauma patients; however, the ability to measure markers of inflammation is still limited at many hospitals. With improving technology and increasing research interest, understanding of the significance of the immunoinflammatory response system in injured patients will continue to evolve.