The trauma and the operation of femoral fractures provoke a double increase inflammatory reaction.

We studied the CRP and how it is influenced form the time and the type of operation.

70 patients, without malignancy or infection, age 80 ± 7 years.

The values of CRP were measured on admission, before operation and 48 hours postoperative.

The patients were grouped:

Group 1: Operation at 1–3 day

Group 2: Operation at 4–6 day

Group 3: operation after 7 day

And in relation with type of operation

TGN 23, DHS 19, HEMIARTHROPLASTY 28

The CRP presents a double increase from the trauma to osteosynthesis and at 48 hours after operation. The first moderate increase is presented from the immediate to late osteosynthesis.

The second increase is presented at group of late osteosynthesis and TGN> DHS> HEMIARTH.

In conclusion the maximum postoperative inflammatory reaction at patients who sustained fractures of femoral neck is measured at 3d and at 6th postoperative day, while before the operation there weren’t any important and statistically differences of CRP values.

In comparison with the type and the method of operation, the CRP presents differences between Hemiarthroplasty and (TGN-DHS).

Diaphyseal femoral fracture (DFF) and fixation elicit a bistep inflammatory response (two-hit model). The timing of fixation potentially affects lung function and blood biochemistry. In 24 patients with DFF we measured CRP, albumin, albumin/globulin ratio (A/G) total protein, triglycerides, low (LDC) and high (HDC) density cholesterol at (1) admission, (2) day of operation, and (3) 48 hours postoperatively. We considered group A: (early fixation, day 1–4, 2.6±0.9, n=12) and B: (late fixation, day 5–12, 8.7±2.6, n=12). Statistical analysis was performed by ANOVA and multivariable tests. CRP increases from injury to operation and further to 48 hours postoperatively (p< 0.001) in both groups. Early fixation results in vigorous CRP increase, compared to late fixation, yet the pattern is parallel. Biphasic decrease of albumin (p< 0.001), A/G (p< 0.001) and total protein (p< 0.001), attributable to the inflammatory response, and that of HDC (p< 0.001) and LDC (p< 0.05) are identical in both groups.

It is known that CRP peaks at 48 hours posttrauma. In early operation there is an additive effect of the two inflammatory hits, whereas, in delayed fixation the first hit fades, thus lowering the starting point of the second hit. Protein and HDC biphasic drop is not affected by the timing of fixation. We have no explanation for HDC drop. The timing of femoral shaft fracture fixation affects significantly CRP release and its impact on convalescence is worth investigating.