Comment on “Comparison of systemic inflammatory responses of proximal femoral nail versus dynamic hip screw after treatment of patients with pertrochanteric fractures: A prospective comparative study”

Abstract

We read the article by Grezda et al1 about systematic inflammatory responses of surgeries in pertrochanteric fractures. It was reported that the application of the proximal femoral nail (PFN) resulted in a significantly smaller increase of interleukin-6 (IL-6) and creatine kinase (CK) from baseline to 24 hours postoperatively compared to dynamic hip screw (DHS), but not in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). We applaud their achievement. However, there was no statement on blood loss and perioperative blood management strategies in the article. Excessive blood loss might call for the implementation of blood management strategies, for example, tranexamic acid, which is widely used in orthopedic surgeries and might cause a change in postoperative inflammatory responses. Postoperative CRP, IL-6, and ESR were reported to be significantly lower with an additional dose of tranexamic acid in total knee arthroplasty (TKA)2, 3 and total hip arthroplasty (THA)4. An extra anti-inflammatory effect from tranexamic acid might have resulted from its inhibition of plasminogen which binds to various inflammatory cells including monocytes, macrophages, and neutrophils5. Author Contributions: Writing Q.F.; Critical Review G.W.