Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 1;35(3):121-127.
doi: 10.1097/BOT.0000000000001925.

Utility of Common Biomarkers for Diagnosing Infection in Nonunion

Mark R Brinker  1   2   3 , Jenny Macek  2   3 , Mitzi Laughlin  1 , Warren R Dunn  1
Affiliations

Utility of Common Biomarkers for Diagnosing Infection in Nonunion

Mark R Brinker et al. J Orthop Trauma. .

Abstract

Objectives: To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions.

Design: A single-gate (cohort) design was used, using 1 set of eligibility criteria applied to a consecutive sample of nonunions.

Setting: Private quaternary referral center.

Patients/participants: Inclusion criteria were consecutive patients (≥18 years) with a nonunion requiring surgery that allowed for direct or medullary canal tissue sampling from the nonunion site. The cohort included 204 subjects with 211 nonunions.

Intervention: Blood samples were drawn for laboratory analysis of WBC, ESR, and CRP before surgery.

Main outcome measurements: The reference standard used to define infection was the fracture-related infection confirmatory criteria. Measures of diagnostic accuracy were calculated. To assess the additional diagnostic gain of each index lab test while simultaneously considering the others, logistic regression models were fit.

Results: The prevalence of infection was 19% (40 of 211 nonunion sites). The positive likelihood ratios (95% confidence interval) for WBC, ESR, and CRP were 1.07 (0.38-3.02), 1.27 (0.88-1.82) and 1.57 (0.94-2.60), respectively. Multivariable modeling adjusted for the effect of preoperative antibiotics showed that WBC (P = 0.42), ESR (P = 0.48), and CRP (P = 0.23) were not significant predictors of infection.

Conclusions: In this consecutive sample of 211 nonunions in whom standard clinical practice would be to obtain index lab tests, our findings showed that WBC, ESR, and CRP were not significant predictors of infection.

Level of evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Glaudemans AW, Jutte PC, Cataldo MA, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019;46:957–970.
    1. Stucken C, Olszewski DC, Creevy WR, et al. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg Am. 2013;95:1409–1412.
    1. Wang S, Yin P, Quan C, et al. Evaluating the use of serum inflammatory markers for preoperative diagnosis of infection in patients with nonunions. Biomed Res Int. 2017;2017:9146317.
    1. Olszewski D, Streubel PN, Stucken C, et al. Fate of patients with a “surprise” positive culture after nonunion surgery. J Orthop Trauma. 2016;30:e19–e23.
    1. Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6:e012799.