Kushtrim GREZDA, Mislav JELIC, Armond DACI, Cen BYTYQI, Qerim KIDA

Comparison of systemic inflammatory responses of proximal femoral nail versus dynamic hip screw after treatment of patients with pertrochanteric fractures: A prospective comparative study

Objective: The aim of this study was to investigate the differences between the induction of early postoperative inflammatoryresponse and muscle tissue injury biomarkers after treatment of pertrochanteric fractures by dynamic hip screw (DHS) orproximal femoral nail (PFN).Methods: In this prospective comparative study, 40 patients with AO-Müller/Orthopaedic Trauma Association (AO/OTA) 31.A1–31.A2 pertrochanteric fractures were enrolled and allocated one of the two groups based on the treatment type: groupDHS, (n =20,mean age = 78.4 ± 6.9 years) and group PFN (n = 20, mean age = 77.75 ± 7.0 years). Operation time was recorded inboth groups. In each patient, circulating levels of high sensitivity interleukin-6 (hs-IL-6), C-reactive protein (CRP), and creatinekinase (CK), and erythrocyte sedimentation rate (ESR) were measured from blood samples collected 1 hour preoperatively and24 hours postoperatively.Results: The operation time was slightly shorter in group PFN than in group DHS (51.9 ± 21.1 and 38 ± 15.2 min, respectively;P = 0.02). DHS and PFN both increased hs-IL-6 (143.81 ± 89.12 and 94.13 ± 67.14, respectively), CRP (98.84 ± 31.81 and 104.4 ±31.80, respectively), and CK (400.8 ± 31.81 and 250.7 ± 31.80, respectively) 24 hours postoperatively. However, PFNcompared to DHS resulted in a lesser increase from baseline to 24 hours postoperatively only in hs IL-6 (58.91 ± 59.02 vs113.30 ± 76.24, respectively; P = 0.0016) and CK (163.6 ± 123.3 vs 310.0 ± 198.3, respectively; P < 0.0001). Moreover, there wasa positive correlation of CK levels’ surgery time in DHS (r = 0.38, P = 0.0065) and PFN (r = 0.45, P = 0.0013).Conclusion: The results of this study have shown that PFN can induce a lower early postoperative inflammatory response andmuscle tissue injury based on the assessment of hs-IL-6 and CK levels, compared to DHS in after the treatment patientspertrochanteric fractures.Level of Evidence: Level II, Therapeutic Study

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