Injury - 2026-08-19 - Journal Article
Cytokine release after geriatric coxal monotrauma.
Pass B, Boerner A, Bousch JF, Schoeps D, Maus U, Kupschus J, Eschbach D, Ruchholtz S, Lendemans S, Schoeneberg C
Topics
Key Takeaway
Geriatric proximal femur fracture patients had significantly elevated preoperative IL-6 and IL-6/IL-10 ratios compared to elective THA controls, but elective THA produced a stronger acute postoperative IL-6 surge.
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Summary
This study compared serial cytokine profiles (IL-6, IL-10, MCP-1/CCL2) in geriatric proximal femur fracture patients versus elective THA controls and young healthy controls, sampling at 5 perioperative timepoints. Fracture patients demonstrated significantly elevated preoperative IL-6 and IL-6/IL-10 ratios, indicating a pre-existing pro-inflammatory state prior to surgical intervention. Elective THA patients surpassed fracture patients in IL-6 levels immediately postoperatively, while MCP-1/CCL2 and IL-10 did not differ between groups at any timepoint.
Key Limitation
The study is limited to a 7-day follow-up window, so whether the observed preoperative cytokine elevation correlates with clinically meaningful outcomes such as mortality, delirium, or complications remains unestablished.
Original Abstract
PURPOSE
Interleukin-6 (IL-6), interleukin-10 (IL-10), and monocyte chemoattractant protein-1 (MCP-1), also known as chemokine (C-C motif) ligand 2 (CCL2), are pivotal mediators of the immune response following trauma. While IL-6 predominantly promotes inflammation, IL-10 serves a regulatory function, and MCP-1/CCL2 facilitates monocyte recruitment and differentiation. Dysregulation of these cytokines has been linked to adverse postoperative outcomes in geriatric patients. An investigation was conducted to analyze the cytokine release profile in geriatric patients with proximal femur fractures and to compare it with that of a geriatric non-trauma group undergoing a comparable operative procedure.
METHODS
Patients older than 70 with proximal femur fractures were enrolled alongside geriatric patients undergoing elective hip arthroplasty and a young (<50 years) healthy control group. Blood samples were collected preoperatively, immediately postoperatively, and on postoperative days 1, 4, and 7 for cytokine quantification.
RESULTS
Preoperative IL-6 and IL-6/IL-10 ratios were significantly higher in trauma patients. IL-6 remained higher immediately postoperatively but was surpassed by THA patients. MCP-1/CCL2 and IL-10 did not differ between groups.
CONCLUSION
Geriatric fracture patients exhibited a pronounced preoperative pro-inflammatory state, whereas elective THA was associated with a strong acute postoperative inflammatory response. Cytokine profiling may aid perioperative risk stratification and management in vulnerable populations.