Creatine kinase in tibial shaft fractures. Serum creatine kinase levels in patients with tibial shaft fractures

Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: A prospective, randomized, controlled trial

It is proposed that the use of biochemical markers for muscle damage and inflammation provides an objective measure on invasiveness in total hip arthroplasty. We analyzed levels of creatine kinase and C-reactive protein (CRP) after total hip arthroplasty in patients randomized to minimally invasive direct anterior approach or direct lateral approach, also recording consumption of pain medication and levels of pain postoperatively. Eighty-three patients were operated by the use of anterior approach and eighty using lateral. Creatine kinase and CRP levels were measured preoperatively, creatine kinase directly after surgery, and both creatine kinase and CRP on postoperative day 1 through 4. The use of pain medication and levels of pain were recorded. Creatine kinase were higher in the anterior group compared to the lateral group, reaching statistical significance directly postoperative and on day 4. Levels of CRP did not differ, reaching a maximum of mean 52 mg/L on day 3. The use of pain medication was higher in the lateral group on the day of surgery (p = 0.011), and pain levels were higher on all days in the lateral group (p < 0.007). In conclusion, the use of minimally invasive anterior approach caused less pain, but higher postoperative levels of CK, than the use of direct lateral approach.

Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers

BACKGROUND

A number of surgical approaches are utilized in total hip arthroplasty. It has been hypothesized that the anterior approach results in less muscle damage than the posterior approach. We prospectively analyzed biochemical markers of muscle damage and inflammation in patients treated with minimally invasive total hip arthroplasty with an anterior or posterior approach to provide objective evidence of the local soft-tissue injury at the time of arthroplasty.

METHODS

Twenty-nine patients treated with minimally invasive total hip arthroplasty through a direct anterior approach and twenty-eight patients treated with the same procedure through a posterior approach were prospectively analyzed. Perioperative and radiographic data were collected to ensure cohorts with similar characteristics. Serum creatine kinase (CK), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-a) levels were measured preoperatively, in the post-anesthesia-care unit (except for the CRP level), and on postoperative days 1 and 2. The Student t test and Fisher exact test were used to make comparisons between the two groups. Independent predictors of elevation in levels of markers of inflammation and muscle damage were determined with use of multivariate logistic regression analysis.

RESULTS

The levels of the markers of inflammation were slightly decreased in the direct-anterior-approach group as compared with those in the posterior-approach group. The rise in the CK level in the posterior-approach group was 5.5 times higher than that in the anterior-approach group in the post-anesthesia-care unit (mean difference, 150.3 units/L [95% CI, 70.4 to 230.2]; p < 0.05) and nearly twice as high cumulatively (mean difference, 305.0 units/L [95% CI, -46.7 to 656.8]; p < 0.05).

CONCLUSIONS

We believe that the anterior total hip arthroplasty approach used in this study caused significantly less muscle damage than did the posterior surgical approach, as indicated by serum CK levels. The clinical importance of the rise in the CK level needs to be delineated by additional clinical studies. The overall physiologic burden, as demonstrated by measurement of inflammation marker levels, appears to be similar between the anterior and posterior approaches. Objective measurement of muscle damage and inflammation markers provides an unbiased way of determining the immediate effects of surgical intervention in patients treated with total hip arthroplasty.

Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers

BACKGROUND

A number of surgical approaches are utilized in total hip arthroplasty. It has been hypothesized that the anterior approach results in less muscle damage than the posterior approach. We prospectively analyzed biochemical markers of muscle damage and inflammation in patients treated with minimally invasive total hip arthroplasty with an anterior or posterior approach to provide objective evidence of the local soft-tissue injury at the time of arthroplasty.

METHODS

Twenty-nine patients treated with minimally invasive total hip arthroplasty through a direct anterior approach and twenty-eight patients treated with the same procedure through a posterior approach were prospectively analyzed. Perioperative and radiographic data were collected to ensure cohorts with similar characteristics. Serum creatine kinase (CK), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-a) levels were measured preoperatively, in the post-anesthesia-care unit (except for the CRP level), and on postoperative days 1 and 2. The Student t test and Fisher exact test were used to make comparisons between the two groups. Independent predictors of elevation in levels of markers of inflammation and muscle damage were determined with use of multivariate logistic regression analysis.

RESULTS

The levels of the markers of inflammation were slightly decreased in the direct-anterior-approach group as compared with those in the posterior-approach group. The rise in the CK level in the posterior-approach group was 5.5 times higher than that in the anterior-approach group in the post-anesthesia-care unit (mean difference, 150.3 units/L [95% CI, 70.4 to 230.2]; p < 0.05) and nearly twice as high cumulatively (mean difference, 305.0 units/L [95% CI, -46.7 to 656.8]; p < 0.05).

CONCLUSIONS

We believe that the anterior total hip arthroplasty approach used in this study caused significantly less muscle damage than did the posterior surgical approach, as indicated by serum CK levels. The clinical importance of the rise in the CK level needs to be delineated by additional clinical studies. The overall physiologic burden, as demonstrated by measurement of inflammation marker levels, appears to be similar between the anterior and posterior approaches. Objective measurement of muscle damage and inflammation markers provides an unbiased way of determining the immediate effects of surgical intervention in patients treated with total hip arthroplasty.

The fibular reciprocal fracture in tibial shaft fractures caused by indirect violence

A series of 200 consecutive junctional middle-distal third tibial shaft fractures caused by indirect violence was analysed with emphasis on the significance of the location of the fibular reciprocal fracture. The fibular fracture was eccentric, i.e. subcapital or malleolar, in 96 patients. This fracture pattern was encountered only in adults and showed significantly more severe initial displacement and with conservative treatment longer union time than fractures with intact fibula or the fibular fracture on the same level with the tibial fracture. Especially for fractures with an initial lateral displacement of more than one half of the diaphyseal diameter and with an eccentric fibular reciprocal fracture internal fixation with uncomplicated postoperative course shortened the union time and prevented residual deformity. A malleolar fibular fracture and the rare separate displaced posterior triangle fracture should in addition as such be regarded as indications for osteosynthesis.