Strony John, Paziuk Taylor, Fram Brianna, Plusch Kyle, Chang Gerard, Krieg James
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA. 19107, USA.
J Bone Jt Infect. 2020 Feb 21;5(2):54-59. doi: 10.7150/jbji.44116. eCollection 2020.
Fracture-related infection (FRI) is a common complication associated with orthopaedic fracture care. Diagnosing these complications in the preoperative setting is difficult. Platelets are a known acute phase reactant with indices that change in accordance with infection and inflammation. The purpose of our study was to assess the diagnostic utility of platelet indices at assessing FRI. A retrospective review performed for all patients who underwent revision surgery for fracture nonunion between 2013 and 2018. Radiographs were employed to define nonunion. Intraoperative cultures were used to define FRI. Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic ability of preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and the platelet count/mean platelet volume ratio (P/V) at recognizing FRI. Of the 53 revision surgeries that were performed for fracture nonunion, 17 (32.1%) were identified as FRI. There were no significant demographic differences between the two cohorts. Patients with FRIs exhibited higher values for ESR (54.82 vs. 19.16, p<0.001), CRP (0.90 vs. 0.35, p=0.003), and P/V (37.4 vs. 22.8, p<0.001) as compared to those within the aseptic nonunion cohort. ROC curve analysis for P/V demonstrated that at an optimal ratio of 23, area under the curve (AUC) is 0.814, specificity is 55.6%, and sensitivity is 100.0%. There was no significant difference in the diagnostic performance of the serum biomarkers but only ESR and P/V had an AUC greater than 0.80. The negative predictive value (NPV) for P/V, ESR, and CRP was 100.0%, 84.6%, and 78.6%, respectively. The P/V ratio may serve as a reliable screening test for FRI.
骨折相关感染（FRI）是骨科骨折治疗中常见的并发症。在术前阶段诊断这些并发症很困难。血小板是一种已知的急性期反应物，其指标会随着感染和炎症而变化。我们研究的目的是评估血小板指标在评估FRI方面的诊断效用。对2013年至2018年间因骨折不愈合接受翻修手术的所有患者进行了回顾性研究。通过X线片来定义骨折不愈合。术中培养用于定义FRI。采用受试者操作特征（ROC）曲线分析来评估术前红细胞沉降率（ESR）、C反应蛋白（CRP）以及血小板计数/平均血小板体积比（P/V）在识别FRI方面的诊断能力。在为骨折不愈合进行的53例翻修手术中，17例（32.1%）被确定为FRI。两组之间在人口统计学上没有显著差异。与无菌性骨折不愈合组相比，FRI患者的ESR（54.82对19.16，p<0.001）、CRP（0.90对0.35，p=0.003）和P/V（37.4对22.8，p<0.001）值更高。P/V的ROC曲线分析表明，在最佳比值为23时，曲线下面积（AUC）为0.814，特异性为55.6%，敏感性为100.0%。血清生物标志物的诊断性能没有显著差异，但只有ESR和P/V的AUC大于0.80。P/V、ESR和CRP的阴性预测值分别为100.0%、84.6%和78.6%。P/V比值可作为FRI的可靠筛查试验。
