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.
Highlights
Increases in C-reactive protein (CRP) and white blood cell (WBC) counts after orthopedic surgical procedures can give evidence of postoperative infection
The postoperative kinetics of systemic CRP concentrations need further investigation to differentiate between elevation related to a surgical procedure and elevation associated with infection in the postoperative course
Demographics and clinical outcomes of cohorts The overall study cohort consisted of 125 patients who were admitted to our hospital for humeral fracture fixation
Summary
Increases in C-reactive protein (CRP) and white blood cell (WBC) counts after orthopedic surgical procedures can give evidence of postoperative infection. Uneventful postoperative courses show a temporary increase in CRP levels [18,19,20,21] For these reasons, the postoperative kinetics of systemic CRP concentrations need further investigation to differentiate between elevation related to a surgical procedure and elevation associated with infection in the postoperative course. The kinetics of systemic CRP and WBC depend on both the severity and type of surgical procedure (e.g., tissue damage) as well as patient-related circumstances (e.g., health status, comorbidities) [22,23,24]. Investigating these effects in relation to specific anatomical regions and different operative procedures is important
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