Reliability of inflammatory markers as predictors of infection in open long bone fractures

Abstract

Introduction and Aim: Open fractures are associated complications such as infections, osteomyelitis, non- union. Levels of CRP, ESR and TLC increases during various types of tissue injury. This study aimed at estimating the effect of deranged peri-operative CRP, ESR, in patients with open long bone fractures and to assess them as significant peri-operative markers of postoperative infection. Methodology: Patients with open long bone fractures during the period Jan 2019 to June 2020 were selected for the study. Serum CRP, ESR and TLC levels were measured preoperatively and on postoperative days 3 and 10. Patients were followed up in the ward for 14 days and after 6 weeks for signs of infection. These pre-operative, post-operative data and incidence of infection were estimated. Results: In the present study 5 out of 32 cases developed infection. In infected cases CRP values were persistently elevated on post-operative day 3 and 10 while in non- infection group it elevated on postoperative day 3 and dropped to lower levels by postoperative day 10. It was statistically significant on preoperative data and on post-operative 10th day data. While the ESR and total WBC count showed no such correlation. Conclusion: Serial CRP measurements can be considered as a more definitive reliable inflammatory marker as compared to ESR and total white blood cell count, in predicting postoperative infections in open long bone fractures. The elevated serial CRP levels postoperatively and their continued persistence in open fractures is potentially an early screening tool for infection before clinical signs of infection appear.