ORIGINAL ARTICLE Value of procalcitonin in differentiating post-surgical systemic and infectious complications from inflammatory reaction caused by surgical trauma in fracture surgery: preliminary report Gu ¨ven Bulut Æ Davud Yasmin Æ Dursun Ak Æ Muzaffer Yy ´ldy ´z Received: 5 March 2009 / Accepted: 13 May 2009 Ó Springer-Verlag 2009 Abstract Effect of fracture itself and fracture surgery to serum procalcitonin levels and the value of procalcitonin in differentiating inflammatory reaction caused by fracture surgery from post-surgical complications were investigated in this study. Twenty-nine patients over 50 years old who underwent surgery for hip fractures were evaluated. Pro- calcitonin, C-reactive protein, white blood cell count and body temperature were measured before surgery and for 5 days postoperatively. Preoperatively, procalcitonin levels were lower than the normal in all patients. It made a peak on the first postoperative day without exceeding the normal range and returned to preoperative level on the fifth day. In contrast to C-reactive protein, which was above the nor- mal in all patients, procalcitonin levels were higher than the normal only in patients with systemic and infectious complications. Procalcitonin seems to be much superior to other infection parameters based on the fact that it is not affected by inflammatory response resulting from fracture itself and fracture surgery, it provides a faster response to surgical trauma, it declines more rapidly after removal of the factor leading to the inflammatory response, it follows a standard postoperative kinetics. It has to be a warning sign for systemic and infectious complications, when postoperative procalcitonin levels have been above 0.5 ng/ml. Keywords Fractures Á Surgery Á Systemic inflammatory response syndrome Á Biological markers Á Procalcitonin Á Postoperative complications Introduction Early diagnosis of infections and introduction of an appropriate treatment following the orthopedic surgery is critical in the prognosis and prevention of potential eco- nomic burden. Although the early diagnosis of post-surgi- cal infection is usually clinical in most cases, sometimes diagnostic testing is needed to determine acute infectious complications following fracture surgery. However, parameters such as white blood cell count (WBC), eryth- rocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are mostly preferred for fracture surgery, are not specific to the infection and they measure acute phase reaction (APR). Also, APR is not a specific condition for infection and affected by multiple factors, such as immu- noallergic reaction, thermal burn injury, trauma, surgery and malignancy. Furthermore, both the fracture itself and the inflammatory reaction caused by the surgery have serious impacts on these parameters [1–4]. A useful infection marker for orthopedic fracture surgery should suggest postoperative infectious complications, should not be affected by fracture itself and surgical trauma, should be specific for bacterial infections and should have quick This paper was presented as a long oral presentation at the 26th Annual Meeting of the European Bone and Joint Infection Society, in Corfu Island-Greece, 20–22 September 2007. G. Bulut (&) Á D. Yasmin Á D. Ak Á M. Yy ´ldy ´z Orthopedics and Traumatology Department, Dr. Lu ¨tfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey e-mail: guvenbulut@yahoo.com D. Yasmin e-mail: davudyasmin@yahoo.com D. Ak e-mail: dr.sun_keah@yahoo.com M. Yy ´ldy ´z e-mail: muzaffer.yildiz@sbkeah.gov.tr 123 Eur J Orthop Surg Traumatol DOI 10.1007/s00590-009-0485-z