[Can procalcitonin be used for the diagnosis and follow-up of postoperative complications after fracture surgery?].
OBJECTIVE
We investigated the effect of fracture surgery on serum procalcitonin levels and the value of procalcitonin in differentiating inflammatory reaction caused by fracture surgery from postoperative infective complications.


METHODS
Twenty-one patients (8 women, 13 men; mean age 72.5 years; range 50 to 105 years) who underwent surgery for pertrochanteric hip fractures were evaluated according to the procedures employed, namely osteosynthesis, and hemiarthroplasty. Procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and body temperature were measured before surgery and for five days postoperatively.


RESULTS
No postoperative wound infections occurred. Seven patients developed complications. The mean preoperative CRP level was five times above the normal. It made a peak on the second day and then began to decrease, but still was four times higher than the preoperative level on the fifth day. Preoperatively, the mean PCT level was lower than the normal in all the patients. It made a peak on the first postoperative day without exceeding the normal range and returned to the preoperative level on the fifth day. In contrast to CRP levels which were above the normal in all the patients, PCT levels were higher than the normal only in patients who developed complications. Taking the cut-off value as = or >0.5 ng/ml, the sensitivity and specificity of PCT to determine systemic complications were 100% and 100% on the first day, and 100% and 50% on the second day, respectively.


CONCLUSIONS
Procalcitonin may prove to be a useful parameter to identify early postoperative systemic complications after fracture surgery.
Yasmin
Davut
D
Department of Orthopedics and Traumatology (2. Ortopedi ve Travmatoloji Kliniği), Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Bulut
Güven
G
Yildiz
Muzaffer
M
D000210:Acute-Phase Reaction / Q000097:blood / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D011859:Radiography; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide