C-reactive protein and tumour diagnosis predict survival in patients treated surgically for long bone metastases

Nonunion remains a major complication of the management of long bone fractures. The primary aim of the present study was to investigate whether raised levels of C-reactive protein (CRP) and white blood cell count (WBC), in the absence of clinical signs, are correlated with positive intraoperative tissue cultures in presumptive aseptic long-bone nonunions. Infection was classified as positive if any significant growth of microorganisms was observed from bone/tissue samples sent from the theater at the time of revision surgery. Preoperatively all patients were investigated with full blood count, white blood count differential as well as C-reactive protein (CRP). A total of 105 consecutive patients (59 males) were included in the study, with an average age of 46.76 years (range 16–92 years) at the time of nonunion diagnosis. The vast majority were femoral (56) and tibial (37) nonunions. The median time from the index surgical procedure to the time of nonunion diagnosis was 10 months (range 9 months to 10 years). Positive cultures revealed a mixed growth of microorganisms, with coagulase-negative Staphylococcus (56.4%) being the most prevalent microorganism, followed by Staphylococcusaureus (20.5%). Pseudomonas, Methicillin-Resistant Staphylococcus aureus (MRSA), coliforms and micrococcus were present in the remainder of the cases (23.1%). Overall, the risk of infection with normal CRP levels (<10 mg/L) was 21/80 = 0.26. Elevated CRP levels (≥10 mg/L) increased the risk of infection to 0.72. The relative risk given a positive CRP test was RR = 0.72/0.26 = 2.74. Overall, the WBC count was found to be an unreliable marker to predict infection. Solid union was achieved in all cases after an average of 6.5 months (3–24 months) from revision surgery. In patients with presumed aseptic long bone nonunion and normal CRP levels, the risk of underlying low-grade indolent infection can be as high as 26%. Patients should be made aware of this finding, which can complicate their treatment course and outcomes.

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The C-reactive protein (CRP) in patients with long bone fractures and after arthroplasty

International Orthopaedics ◽

10.1007/bf00186386 ◽

1993 ◽

Vol 17 (3) ◽

Cited By ~ 7

Author(s):

S.I. Yoon ◽

S.S. Lim ◽

J.D. Rha ◽

Y.H. Kim ◽

J.S. Kang ◽

...

Keyword(s):

Bone Fractures ◽

Long Bone ◽

C Reactive Protein ◽

Reactive Protein ◽

Long Bone Fractures

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Bone Tuberculosis: Clinical Profile of 40 Patients in Dr. Soetomo General Hospital Surabaya

JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga ◽

10.20473/juxta.v11i12020.1-5 ◽

2020 ◽

Vol 11 (1) ◽

pp. 1

Author(s):

Yonatan Esli Alexander Tidja ◽

Sjahjenny Mustokoweni ◽

Tania Ardiani Saleh

Keyword(s):

Family History ◽

Vascular Supply ◽

Clinical Profile ◽

Smoking History ◽

Long Bone ◽

Growth Line ◽

C Reactive Protein ◽

Elderly Male ◽

Reactive Protein ◽

Normal Number

Introduction: Bone and joint tuberculosis are specific infection inflammation of Mycobacterium tuberculosis, mostly affected bone and joint confirmed by acceleration of vascular supply to vertebrae and growth line of long bone. The aim of this study is to know clinical profile of bone and joint tuberculosis’ patients. Methods: This study was conducted using descriptive observational method, samples were tested by observation descriptive test. Results: The average ages of bone and joint tuberculosis hospitalized patients of RSUD Dr. Soetomo Surabaya are 35-44 years. There are 22 cases on male (55%) and 18 cases on female (45%) with 29 subjects of Hb’s abnormal number (72.5%), 15 subjects of abnormal leucocytes (37.5%), 20 subjects of abnormal thrombocyte (50%), 34 subjects of abnormal ESR (94.4%), 20 patients of abnormal C-reactive protein (54.1%), 11 subjects of abnormal serum creatinine (28.9%), 13 subjects of abnormal sodium level (35.1%), 15 patients of abnormal potassium level (40.5%), and 16 patients of abnormal chloride level (43.2%). There are 16 subjects with smoking history (40%), 29 subjects of positive tuberculosis history (72.5%), 6 subjects with positive tuberculosis family history (15%), 30 subjects of pain as main problems (75%), 5 subjects of swelling or pus as main problems (12.5%), 5 subjects of extremities disability as main problems (12.5%). Dominant location of infection is vertebrae (95%) which are suffered by 38 subjects with thoracal as the main level of infection, suffered by 15 subjects (50%). Other levels of infection are lumbal with 12 subjects (40%), cervical with 3 subjects (10%), and pelvis or thigh with 2 subjects (5%). Conclusion: From 40 subjects, bone and joint tuberculosis mostly suffered by elderly, male risks more than female. Most of hematology tests results were abnormal. Most subjects suffered abnormal C-reactive protein. Most subjects’ hematology tests were BUN, creatinine serum, and electrolyte normal. Number of subjects with smoking habits was dominant. Most subjects were having tuberculosis history but negative family history. Most subjects complained about pain with vertebrae level thoracal as dominant location of infection.

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