<p>Usefulness of serum D-dimer for preoperative diagnosis of infected nonunion after open reduction and internal fixation</p>

Abstract

Purpose Infected nonunion after open reduction internal fixation (ORIF) is a serious complication. The aim of this study was to evaluate the usefulness of serum D-dimer for preoperative diagnosis of infected nonunion. Patients and methods Patients undergoing debridement and external fixation for infected nonunion (n=32) and replacement of internal fixation due to aseptic failure (n=34) were enrolled and compared in this retrospective study. The optimum cutoff value of D-dimer for identification of infected nonunion was determined by calculating the Youden J statistic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of four preoperative laboratory parameters—serum D-dimer level, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)—for diagnosis of infected nonunion were compared. Results Serum D-dimer level was significantly higher in patients with infected nonunion than in patients with aseptic nonunion: 2.62 mg/mL (range, 0.13–11.90 mg/mL) vs 0.35 mg/mL (range, 0.07–6.46 mg/mL; p <0.001). WBC count, CRP, and ESR demonstrated sensitivity of 12.5% (95% CI: 4.08–29.93), 40.6% (95% CI: 24.22–59.21), and 56.3% (95% CI: 37.88–73.16), respectively, and specificity of 94.1% (95% CI: 78.94–98.97), 88.2% (95% CI: 71.61–96.16), and 85.3% (95% CI: 68.17–94.46), respectively. Using the Youden index, 1.70 mg/mL was determined as the optimal threshold value for serum D-dimer for the diagnosis of infected nonunion. The sensitivity and specificity of serum D-dimer (>1.70 mg/mL) were 75.0% (95% CI: 56.25–87.87) and 91.2% (95% CI: 75.19–97.69). Conclusions Serum D-dimer level may be useful for preoperative prediction of infected nonunion in patients after ORIF.

A Retrospective Comparison Of Platelet Indices For Diagnosing Infected Nonunion

“…Until now, numerous studies have evaluated the performances that brinogen, D-dimer and platelet indices play in diagnosis of PJI, and most of these studies proved that brinogen, D-dimer and platelet indices were associated with PJI [27-29, 18, 30, 31]. Previous studies have demonstrated that the diagnostic values of plasma brinogen and serum D-dimer for diagnosis infected nonunion were good and compared with plasma D-dimer, plasma brinogen had better performance in diagnosing infected nonunion, which was consistent with the ndings in this study [19,32]. Based on our data, plasma brinogen had the higher AUC (0.807) than plasma D-dimer (0.755).…”

“…Inspired by this, many scholars have focused on exploring the potential values of coagulation-related parameters for diagnosing orthopaedic infections and have obtained positive outcomes that brinogen, D-dimer and PC are useful in reaching or refuting the diagnosis of periprosthetic joint infection (PJI) [14][15][16][17][18]. Moreover, past studies have indicated that Ddimer and brinogen could be potential diagnostic markers for infected nonunion [19,20]. However, the sample sizes of the studies were not enough large and there is no related study about the accuracy of platelet indices including platelet count (PC), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and PC/MPV in diagnosing infected nonunion after ORIF.…”

Diagnostic value of platelet indices in infected nonunion: a retrospective study

“…Numerous studies have shown that fibrinogen, D-dimer, and platelet indices are associated with PJI [ 18 , 27 – 31 ]. Previous studies have shown that plasma fibrinogen and serum D-dimer have good value for diagnosis of infected nonunion, with the former having significantly better diagnostic value [ 19 , 32 ]. This is consistent with our study, where the AUC of plasma fibrinogen (AUC 0.807) was larger than that of plasma D-dimer (AUC 0.755).…”

“…In the field of orthopedics, fibrinogen, D-dimer, and PC have been found to be useful for diagnosis of periprosthetic joint infection (PJI) [ 14 – 18 ]. Some studies have also indicated that D-dimer and fibrinogen could be potential diagnostic markers for infected nonunion [ 19 , 20 ]; however, the sample sizes of these studies were small. There has been no study so far on the accuracy of platelet indices—including PC, plateletcrit, mean platelet volume (MPV), platelet distribution width (PDW), and PC/MPV ratio—in the diagnosis of infected nonunion after ORIF.…”

A bibliometric analysis of clinical research on fracture‐related infection

“…Furthermore, research topics and concepts also altered over the course of the years. With the introduction of the FRI consensus group, the term “fracture-related infection” became the standard, with more recent topics primarily focusing on risk factors and diagnostic criteria of FRI [ 15 , 40 – 43 ]. Prior to this, researchers focused on the treatment of FRI [ 44 – 46 ], with a focus on debridement, bone transfer, and antibiotic treatment.…”