Inflammatory factors before and after orthopedic surgery in patients with fractures following trauma

Document Type : Original Article

Authors

1 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Orthopedic, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

3 Biostatistics, Kashan University of Medical Sciences, Kashan, Iran

4 Department of Pediatric, Student Research Committee, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

10.4103/atr.atr_22_22

Abstract

Background and Objectives: Inflammatory factors are indicators of complications such as infection following trauma fracture healing that is necessary to identify the process of changes after surgery and the factors affecting it. Therefore, this study aimed to evaluate the extent of inflammatory factors before and after surgery in patients with fractures following trauma. Materials and Methods: This prospective study was performed on 200 patients with fractures requiring surgery. After obtaining patient satisfaction and recording demographic information, the white blood cells (WBC) count, erythrocyte sedimentation rate (ESR), and serum levels of C-reactive protein (CRP) changes before and during the first 6 weeks of the postoperative period were recorded. Repeated measure ANOVA and mixed ANOVA tests were used to compare the data. Results: According to our results, the day after surgery all inflammatory factors including WBC, ESR, and CRP increased significantly, and 2 weeks after surgery serum levels of WBC and CRP decreased, while ESR serum levels were still high and decreased from the 4th week. Conclusions: The results of this study showed the deviation of inflammation factors from the normal ranges and increase and decrease after surgery can indicate the presence of complications such as infection after surgery. Since CRP changes were more sensitive than ESR, it is recommended to check WBC and CRP changes to evaluate infection because ESR was elevated for a longer duration.

Keywords


1.
Miranda MA, Moon MS. Treatment strategy for nonunions and malunions. In: Stannard JP, Schmidt AH, Kregor PJ, editors. Surgical Treatment of Orthopaedic Trauma. New York: Thieme; 2007. p. 77-100.  Back to cited text no. 1
    
2.
Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, et al. Delayed union and nonunions: Epidemiology, clinical issues, and financial aspects. Injury 2014;45 Suppl 2:S3-7.  Back to cited text no. 2
    
3.
Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, et al. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World journal of orthopedics 2016;7:171.  Back to cited text no. 3
    
4.
Jahangir AA, Nunley RM, Mehta S, Sharan A, Fellows TW. Bone-graft substitutes in orthopaedic surgery. AAOS Now 2008;2:1-5.  Back to cited text no. 4
    
5.
Mountziaris PM, Spicer PP, Kasper FK, Mikos AG. Harnessing and modulating inflammation in strategies for bone regeneration. Tissue Eng Part B Rev 2011;17:393-402.  Back to cited text no. 5
    
6.
Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011;42:551-5.  Back to cited text no. 6
    
7.
Claes L, Recknagel S, Ignatius A. Fracture healing under healthy and inflammatory conditions. Nat Rev Rheumatol 2012;8:133-43.  Back to cited text no. 7
    
8.
Maruyama M, Rhee C, Utsunomiya T, Zhang N, Ueno M, Yao Z, et al. Modulation of the inflammatory response and bone healing. Front Endocrinol (Lausanne) 2020;11:386.  Back to cited text no. 8
    
9.
Honsawek S, Deepaisarnsakul B, Tanavalee A, Sakdinakiattikoon M, Ngarmukos S, Preativatanyou K, et al. Relationship of serum IL-6, C-reactive protein, erythrocyte sedimentation rate, and knee skin temperature after total knee arthroplasty: A prospective study. Int Orthop 2011;35:31-5.  Back to cited text no. 9
    
10.
Ellitsgaard N, Andersson AP, Jensen KV, Jorgensen M. Changes in C-reactive protein and erythrocyte sedimentation rate after hip fractures. Int Orthop 1991;15:311-4.  Back to cited text no. 10
    
11.
Mun JH, Kim DH, Ryu KS, Park CK, Kim MC. Diagnostic value of early inflammatory reaction in postoperative infection of the lumbar spine. J Korean Neurosurg Soc 2005;38:206-10.  Back to cited text no. 11
    
12.
Gelalis ID, Arnaoutoglou CM, Politis AN, Batzaleksis NA, Katonis PG, Xenakis TA. Bacterial wound contamination during simple and complex spinal procedures. A prospective clinical study. Spine J 2011;11:1042-8.  Back to cited text no. 12
    
13.
Giehl JP, Kluba T, Lebherz C. The course of inflammatory mediators after elective orthopedic interventions. Z Orthop Ihre Grenzgeb 2000;138:181-4.  Back to cited text no. 13
    
14.
Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clinical Orthopaedics and Related Research (1976-2007). 1992;275:237-42.  Back to cited text no. 14
    
15.
Choi MK, Kim SB, Kim KD, Ament JD. Sequential changes of plasma C-reactive protein, erythrocyte sedimentation rate and white blood cell count in spine surgery: Comparison between lumbar open discectomy and posterior lumbar interbody fusion. J Korean Neurosurg Soc 2014;56:218-23.  Back to cited text no. 15