ABSTRACT
OBJECTIVES: To determine the modification in postoperative D-dimer level as a function of the surgical act and to assess the relevance of this measure for diagnosing thromboembolism. METHOD: A cohort of 179 patients was followed: group 1 comprised 128 patients undergoing lower limb arthroplasty, group 2 comprised 29 patients undergoing lower limb surgery without implant, and group 3 comprised 22 patients undergoing spinal or upper limb surgery. D-dimer level was systematically measured on admission and then once a week for 4 weeks. Doppler ultrasonography was performed on clinical suspicion of deep vein thrombosis. D-dimer levels were compared between patients with and without deep vein thrombosis. RESULTS: D-dimer levels were constantly elevated postsurgery (2- to 6-fold above normal) and returned to normal by week 4 in groups 2 and 3 but remained elevated in group 1 (3-fold above normal). Deep vein thrombosis was suspected in 45 cases and confirmed by Doppler ultrasonography in 10 cases. D-dimer level was not significantly different between patients with deep vein thrombosis and those without. DISCUSSION AND CONCLUSIONS: In the postoperative period, measurement of D-dimer level does not aid in diagnosing thromboembolism since its constant high level obviates any negative predictive value.
Subject(s)
Fibrin Fibrinogen Degradation Products/analysis , Orthopedic Procedures , Postoperative Complications/diagnosis , Venous Thrombosis/diagnosis , Adult , Aged , Early Diagnosis , Female , Humans , Male , Middle Aged , Prospective Studies , Venous Thrombosis/bloodABSTRACT
OBJECTIVES: To evaluate the usefulness of monitoring C-reactive protein (CRP) level and leukocyte count for early diagnosis of infection following orthopedic surgery. METHOD: A cohort of 179 patients was followed: group 1 comprised 128 patients undergoing lower limb arthroplasty, group 2 comprised 29 patients undergoing lower limb surgery without implant, and group 3 comprised 22 patients undergoing spinal or upper limb surgery. CRP level and leukocyte count were systematically measured on admission and then once a week for 4 weeks. Wound infections, other infections, wound disconnection without infection and hematoma were noted. CRP level and leukocyte count were monitored postoperatively in patients with and without complications. RESULTS: CRP level was 4- to 8-fold above the normal range at the first postoperative measurement but normalized within the next 3 weeks (reaching normal levels by the 30th postoperative day, on average). In the 7 cases of wound infection (WI), the CRP level rose to 28-fold above normal and was significantly different from that in without infection or with intercurrent infection (P<0.01). A receiver operating characteristic (ROC) curve was established for CRP level, and for a value of 60 (12-fold above the normal range) the sensitivity was 100%, the specificity 83.6% and the negative predictive value 100%. The variation in leukocyte count was minor, with a significant difference noted between only patients not infected or those with WI (P<0.05). DISCUSSION AND CONCLUSIONS: Measurement of CRP level can be used for early diagnosis of wound infection. In the case of strong clinical suspicion or in the presence of high risk factors, when the level is at 12-fold or more above the normal range, the diagnosis of infection is highly probable.
Subject(s)
C-Reactive Protein/analysis , Leukocyte Count , Orthopedic Procedures , Surgical Wound Infection/diagnosis , Adult , Aged , Early Diagnosis , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and SpecificityABSTRACT
INTRODUCTION: Functional assessments of hand replantation after traumatic amputation are considered as good although frequent deficits of long fingers mobility and hand sensitiveness occur. AIMS: To evaluate the capability of handling and the compensatory mechanisms involved in handling. METHODS: Prospective study in eight right-handed males who had distal amputation of the left upper limb with hand replantation for more than two years. Eight males with paired age and handedness served as control. Skin sensitiveness (thread test), mobility (TAM), functional capability (Box and Blocks test, 400 points test) and occupational outcome were assessed. Three-dimensional analysis (opto-electronic device) of the motion of the trunk and the upper limbs (arm, forearm, hand) was made during a pointing and gripping-shifting maneuver and the time of the related phases was measured (dynamometric cube device). Correlation between clinical assessments and three-dimensional analysis were tested. RESULTS: Patients with replantation had a remarkable recovery of the absolute and relative times of the various phases of the handling maneuver. Only the gripping phase was significantly prolonged in patients, this result was correlated with the deficit in motor function and sensitiveness of the replanted hand. The visual control was higher because of the lack of superficial and deep sensitiveness. Compensatory mechanisms involved a lateral shift of the replanted limb segments, probably attributed to the lateral shift of the trunk. CONCLUSION: Patient with a replanted hand develops a homogenesis displacement of the trunk and the pectoral girdle to compensate the shortening and the reduction in active mobility of the hand. This compensatory mechanism, observed in a small scale in healthy too, is efficient with respect to the handling phases.
