Objectives: Deep surgical site infection (DSSI) is one of the most serious complications after open induction internal fixation (ORIF) for traumatic limb fractures. In this study, we aimed to investigate the diagnostic role of platelet indices (platelet count [PLT], mean platelet volume [MPV], and platelet distribution width [PDW]) in DSSI.
Patients and methods: Data obtained between January 2011 and December 2017 in The Affiliated Drum Tower Hospital of Nanjing University Medical School from cases (n=29) with DSSI and fracture control subjects (n=29) matched for age, gender, and fracture type were analyzed. The white blood cell (WBC) count, neutrophil count, neutrophil percentage, and platelet indices from blood samples were compared between case and control groups. In addition, the cutoff value, sensitivity, and specificity were calculated by receiver-operating characteristic (ROC) curves.
Results: No significant differences were detected in demographic features, the WBC count, neutrophil count, neutrophil percentage, and MPV values between two groups (P >0.05). The PLT values were significantly higher in the case group than in the control group (303.00±139.27 vs 196.10±59.61 [10⁹/μL], P=0.001). The PDW values of the case and control groups were 11.77±2.71 and 13.19±2.39%, respectively, and were significantly lower in the case group (P =0.001). ROC curve analysis suggested a cutoff point for PLT as 215.50 (10⁹/μL, larger values indicate pathology) for the diagnosis of DSSI with the sensitivity and specificity of 79.3 and 72.4%, respectively. For PDW, the cutoff point was 10.35% (smaller values indicate patients) for the diagnosis of DSSI with the sensitivity and specificity of 37.9 and 96.6%, respectively.
Conclusion: Our results suggest that PDW combined with PLT can be used as an important additional test for the diagnosis of DSSI after ORIF for traumatic limb fractures, thus reducing the cost and loss of time.
Keywords: surgical site infection, internal fracture fixation, fracture, platelet count, platelet function test