Exciting Performance of Plasma Fibrinogen in Periprosthetic Joint Infection Diagnosis.

OBJECTIVE: To test the significance of serum C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the platelet count/mean platelet volume ratio (PC/MPV), plasma fibrinogen, and D-Dimer in periprosthetic joint infection (PJI) diagnosis. METHODS: We retrospectively analyzed the clinical data of 149 patients diagnosed from July 2016 to December 2019 with primary osteoarthritis (OA group, average age 63.18 years [range, 53-82 years] 18 males, 46 females), PJI (PJI group, average age 63.74 years [range, 52-81 years], 16 males, 31 females), and aseptic loosening (aseptic group, average age 63.18 years [range, 53-80 years], 12 male, 26 female) in our department. Demographic data and the sensitivity and specificity of preoperative CRP, ESR, PC/MPV, fibrinogen, and D-Dimer in PJI diagnosis were compared. RESULTS: There were no significant differences when the demographic data of the three groups were compared. The expression level of CRP (50.67 ± 58.98 mg/L), ESR (50.55 ± 25.81 mm/h), PC/MPV (35.79 ± 18.00), and fibrinogen (4.85 ± 1.33 µg/mL) in the PJI group were higher than in the OA group (CRP: 4.09 ± 9.68 mg/L; ESR:13.44 ± 9.32 mm/1 h; PC/MPV: 24.97 ± 7.58; fibrinogen: 3.09 ± 0.55 µg/mL) and the aseptic group (CRP: 7.01 ± 11.83 mg/L; ESR: 22.47 ± 17.53 mm/1 h; PC/MPV: 25.18 ± 11.48; fibrinogen: 3.39 ± 0.80 µg/mL), respectively. The expression level of plasma D-dimer (1.60 ± 1.29 mg/L) in the PJI group was higher than in the OA group (0.49 ± 0.42 mg/L) but similar to that in the aseptic group (1.21 ± 1.35 mg/L). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, PC/MPV, fibrinogen, and D-dimer were 0.892 (95% confidence interval, 0.829-0.954), 0.888 (0.829-0.947), 0.686 (0.589-0.784), 0.873 (0.803-0.943), and 0.835 (0.772-0.899), respectively. When PC/MPV > 31.70, fibrinogen >4.01 µg/mL, and D-dimer >1.17 mg/L were set as the threshold values for the diagnosis of PJI, the sensitivity of PC/MPV in PJI diagnosis was lower than that of ESR and plasma fibrinogen. In contrast, there was no significant difference when comparing the specificity of CRP, ESR, PC/MPV, fibrinogen, and D-dimer in PJI diagnosis. CONCLUSION: Plasma fibrinogen is a good new auxiliary diagnostic marker for PJI.

Successful management of lower limb nonunion using locking plates and bone graft with retention of intramedullary nail.

This study aims to investigate the clinical effect of the combined an additional locking plate with bone graft based on retaining the original intramedullary nail for the treatment of lower limb nonunion.From June 2008 to December 2012, 39 patients were admitted and treated, who developed non-infectious bone nonunion after intramedullary nail fixation for long bone fracture in the lower limb. Additional locking plate and autogenous iliac bone grafting were performed for these patients, in which the original intramedullary nail was retained. Follow-ups were performed once at postoperative months 1, 2, 3, 6, and 12, and every year onwards. During these follow-ups, imaging and clinical function examinations were performed, in order to observe callus growth and the fractured limb functions.All patients have been followed-up, in which the duration of these follow-ups ranged between 8 and 24 months. All patients gained bony union within 6 to 11 months, and the healing rate was 100%. Radiographic healing time ranged between 8 and 15 months. Full weight-bearing time ranged between 2 and 10 months. According to Harris hip scores and Hospital for Special Surgery (HSS) Knee joint scores, 17 cases were excellent, 2 cases were good, and 1 case was acceptable; with an excellent and good rate of 95.00%. According to HHS score for the knee, 15 cases were excellent, 3 cases were good, and 1 case was acceptable; with an excellent and good rate of 94.74%.The combined treatment of the additional blocking plate with bone grafting based on retaining the original intramedullary nail for bone nonunion could effectively eliminate lateral and rotatory instability of the fractured ends. This surgical method had a short operation time, high healing rate and other advantages.