Plate osteosynthesis versus hemiarthroplasty in proximal humerus fractures – Does routine screening of systemic inflammatory biomarkers makes sense?

Abstract

BackgroundIncreases in C-reactive protein (CRP) and white blood cell (WBC) counts after orthopedic surgical procedures can give evidence of postoperative infection. However, there is a lack of knowledge about the kinetics of these biomarkers in cases with an uneventful clinical course after osteosynthesis of upper limb fractures. This study investigated CRP and WBC serum levels after osteosynthesis or hemiarthroplasty of humeral head fractures.MethodsA retrospective study on patients with humeral head fractures who had open reduction and internal fixation via plate osteosynthesis (PO) (n = 64) or hemiarthroplasty (HA) (n = 28) without any complications in the postoperative clinical course. C-reactive protein serum levels (mg/l) and leukocyte counts (g/l) were assayed at several time points. Multiple regression analysis was performed to evaluate the influence of several confounding variables (the surgical procedure, duration of surgery, patient’s health status, and comorbidities) on the kinetics of CRP and WBC.ResultsOur data showed that CRP levels were statistically significantly higher in the HA cohort when compared to the PO cohort (p = 0.003). Moreover, daily measurement of CRP levels during the postoperative course showed that CRP peaked on the 2nd and 3rd days postoperatively in both cohorts and started to decrease afterward, reaching normal values on day 8 to 10. However, WBCs did not show any significant differences between the HA and PO cohorts. Finally, the choice of surgical procedure and the patient’s health status were associated with higher peak levels of CRP.ConclusionsAfter osteosynthesis or hemiarthroplasty of humeral head fractures, CRP is a responsive serum parameter in the postoperative course of an uneventful inflammatory response. Abnormalities from these values should be interpreted carefully as they may give a hint as to postoperative complications such as infection.

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

“…Moreover, the value of LC is less well established. 9 , 40 In early postoperative infections after fracture surgery, continuous elevation or a secondary rise might be expected in CRP and LC 24 , 41 . Levels of serum CRP, LC and ESR have been shown to be significantly lower in FRI than in hematogenous osteomyelitis and osteomyelitis of the diabetic foot 42 , 43 .…”

The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients

“…The hepatic synthesis of CRP due to bacterial infection is known to start 6-8 hours after infection, reached its peak on the second-third postoperative day (36 - 50 hours) 58 - 61 , a level of ≥96 mg/L after the fourth day of surgery is highly indicative for deep wound infection 62 . Importantly, the CRP response after orthopaedic surgery is more informative than white blood cell count (WBC) 59 , 63 , absolute neutrophil count and erythrocyte sedimentation rate 58 , 64 , and is not associated with age, gender, type of anaesthesia, operation time, amount of bleeding, transfusion or drugs administered 58 . On these bases persistent elevation and/or second rise in CRP concentrations (CRP>100 mg/L and CRP >150mg/L) after the 3 rd postoperative day were chosen as indicators of possible postoperative infective complications.…”

Growth Factors in the Blood Serum of Patients with Infection Complications of Polytrauma

“…Infection processes are the most challenging complications of high-energy injuries. Their developments are directly related to severity of injury, volume of operative in vasion and prevention measures [8]. But the question remains quite persistent why being under identical conditions and having same scope of medical aid infection complications develop in some patients.…”