Diễn tiến của bilan viêm sau phẫu thuật kết hợp xương bên trong thì đầu ở người bệnh gãy hở xương dài chi dưới

Postoperative infection represents a significant challenge following internal fixation surgery for open fractures of lower limb long bones, severely impacting patient recovery and increasing healthcare burdens. The timely and accurate diagnosis of such complications is paramount for effective treatment and improved outcomes. However, the interpretation of routine inflammatory markers can be complex, as surgical trauma and the fracture itself elicit a systemic inflammatory response, potentially masking early signs of infection. This study aims to delineate the typical progression of key inflammatory indices, specifically C-reactive protein, white blood cell count, and erythrocyte sedimentation rate, to enhance the diagnostic utility of these markers in detecting postoperative infections in this patient population.

Orthopedic surgeons, intensivists, infectious disease specialists, and medical researchers interested in postoperative infection diagnosis and management of musculoskeletal trauma.

This prospective case series investigated the dynamic changes of inflammatory markers in 34 patients undergoing immediate internal fixation for open fractures of lower limb long bones, with the primary goal of improving the diagnosis of postoperative infection. C-reactive protein (CRP), white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) were measured preoperatively and for five consecutive days postoperatively. The study observed distinct patterns in non-infected cases: CRP levels rapidly increased, peaked on day 2, and typically normalized by day 5; WBC count showed a rapid initial increase followed by a decrease; while ESR increased slowly and remained elevated through day 5. In contrast, for the two identified infected cases, CRP demonstrated a second increase or failed to normalize after day 2, ESR showed a progressive increase, and WBC count either continued to rise or exhibited a second peak. The findings suggest that C-reactive protein and white blood cell count are reliable indicators for monitoring postoperative infection when their dynamic progression is considered, especially observing the trend from preoperative, day 2, and day 5 measurements. Conversely, erythrocyte sedimentation rate was found to have limited value in early detection of postoperative infections due to its slower response and prolonged elevation. These insights provide a practical framework for clinicians to interpret inflammatory markers more effectively in the context of open fracture management.