Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures.
BACKGROUND
Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity.


AIM
The objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery.


PATIENTS AND METHODS
This prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4).


RESULTS
We discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM.


CONCLUSIONS
We can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.
['Groznik|Matjaž|M|', 'Cimerman|Matej|M|', 'Lusa|Lara|L|', 'Gorenjec|Nina Ružić|NR|', 'Ihan|Alojz|A|']
D000210:Acute-Phase Reaction D000328:Adult D002097:C-Reactive Protein D005260:Female D005593:Fracture Fixation, Internal D006801:Humans D008297:Male D008875:Middle Aged D010019:Osteomyelitis D011183:Postoperative Complications D011184:Postoperative Period D011237:Predictive Value of Tests D011446:Prospective Studies D000075462:Serum Albumin, Human D013530:Surgical Wound Infection D013978:Tibial Fractures
Albumin Posttraumatic osteomyelitis Tibial fracture CRP PCT Cytokines T regulatory cells CD4+CD25+