Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures

Abstract

Sterile inflammation is a natural response of the organism in the absence of microorganisms, which is triggered in correspondence with the degree of tissue damage sustained after a surgical procedure. The objective of this study was to explore the values of postoperative hematological-derived biomarkers in assessing the sterile inflammatory response magnitude related to the invasiveness of the surgical reduction technique used for subtrochanteric fractures (STFs) treatment. A retrospective, observational cohort research was conducted between January 2021 and October 2023 that included a total of 143 patients diagnosed with acute subtrochanteric fractures who underwent long Gamma Nail (LGN) fixation. According to the surgical reduction technique used, they were divided into two groups: group 1, which consisted of those with a closed reduction and internal fixation (CRIF); and group 2, which consisted of those with an open reduction internal fixation (ORIF). Between groups, statistically significant differences (p < 0.05) were found in relation to days to surgery, length of hospital stay (LOHS), duration of surgery, postoperative hemoglobin (HGB) levels, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The receiver operating characteristics (ROC) curve analysis revealed that all ratios presented a high diagnostic ability (p < 0.0001) with NLR > 6.95 being the most reliable (sensitivity 94.8% and specificity 70.6%). Moreover, the multivariate regression model confirmed that sterile immune response after orthopedic interventions can be assessed in an almost equal and non-dependent manner using these biomarkers. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated to the sterile inflammatory response magnitude, due to the extent of surgical dissection performed during internal fixation procedures of subtrochanteric femur fractures.

Dysregulation of Inflammatory Pathways in Adult Spinal Deformity Patients with Frailty

“…Additionally, no correlation was found between serum CRP level at any post-operative time period and 2-year post-operative SRS22 scores. These findings are in line with the literature indicating that sterile inflammatory responses and associated hematological biomarkers are significantly relevant in the postoperative period for elderly patients undergoing surgical procedures [29,30]. It is therefore plausible that, similar to the ratios indicating sterile inflammation in the context of orthopedic surgeries, the transient postoperative elevations of CRP and transaminase levels in our study serve as reflections of an inflammatory response.…”

Preventing Atrophic Long-Bone Nonunion: Retrospective Analysis at a Level I Trauma Center

“…In order to objectify the impact of surgical trauma in patients, a paper dealing with sterile inflammation after surgical therapy was published only recently. Here, the elevated inflammatory impact of additional surgical trauma from open reduction was highly significant [21]. Besides short-term side effects such as prolonged hospital stay and blood loss, it is tempting to speculate that this additional sterile inflammation might also play a role in nonunion development.…”

Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients

“…As seen in these examples, the tendency is to correlate the markers with postoperative complications, morbidity and morality rates. Few studies, however, have tried to provide an indication for a specific surgical protocol using this perspective [ 37 ]. Wang et el.…”