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

Authors Wang Z, Zheng C, Wen S, Wang J, Zhang Z, Qiu X, Chen Y

Received 23 April 2019

Accepted for publication 29 May 2019

Published 1 July 2019 Volume 2019:12 Pages 1827—1831


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna

Zhen Wang,1,* Chong Zheng,2,* Siyuan Wen,1 Junfei Wang,1 Zitao Zhang,1 Xusheng Qiu,1 Yixin Chen1

1Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, People’s Republic of China; 2Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, People’s Republic of China

*These authors contributed equally to this work

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.

Keywords: fracture-related infection, laboratory test, preoperative prediction, nonunion

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