• Eur J Orthop Surg Tr · Jul 2018

    Observational Study

    C-reactive protein levels for early detection of early postoperative complications after proximal femoral fracture surgery.

    • Romain Schutz, Baptiste Boukebous, Pierre Boutroux, and Pascal Guillon.
    • Department of Orthopaedic Surgery, Le Raincy Montfermeil Intercommunal Hospital, 10 rue du Général Leclerc, 93370, Montfermeil, France. schutzromain@gmail.com.
    • Eur J Orthop Surg Tr. 2018 Jul 1; 28 (5): 907-913.

    IntroductionWe have studied the early C-reactive protein (CRP) kinetics after proximal femoral fracture (PFF) surgery and defined a chart of CRP threshold values beyond which early postoperative complications are likely.Materials And MethodsWe have prospectively followed up a 42-patient cohort for surgical treatment by osteosynthesis or hip arthroplasty, and CRP was dosed at admission, on day 1, day 3, day 5 and then twice weekly for 30 days at the same time as a platelet count control of low molecular weight heparins. Then, we identified postoperative complications (medical complications like infections other than the surgical site, thromboembolic complications, death and surgical complications like surgical site infections, dislocation, haematoma) and established the evolutive profile of CRP in a 'complication' group and a 'no complication' group. We developed a threshold value model for complications detection from our results and compared with Chapman's 500/d formula (d being the postoperative day).ResultsCRP in the 'complication' group (20 patients) is on average 19 points higher than the 'no complication' group (22 patients) (p = 0.007). Our model, which corresponds to the formula CRP(d) = e(4.71 - 0.06*d), is valid from day 1 to day 30 and has a threshold value of 105 mg/L at day 1. From day 5, the correlation between our chart and the 500/d chart is 0.84 (p < 10-5). Two successive CRP values strictly above our chart at a 48-h interval have a sensitivity of 65% and a specificity of 85% to detect a postoperative complication while only one CRP value above the chart has a sensitivity and a specificity of 48%.Discussion/ConclusionEarly postoperative CRP kinetics of PFF surgical patients can be modelled as a threshold value scale valid between day 1 and day 30. This can be an additional tool in the early detection of postoperative complications, if two CRP values are above the threshold values, without replacing the clinical examination, which remains the 'gold standard'.Level Of EvidenceProspective observational study.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…