Can procalcitonin be used for the diagnosis and follow-up of postoperative complications after fracture surgery?

Obj ectives : 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 >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. Conclusion: ftoc alc itonin may prove to be a useful parameter to identify early postoperative systemic complications after fracture surgery.