{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:22:44Z","timestamp":1768911764401,"version":"3.49.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T00:00:00Z","timestamp":1741392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Limited surgical invasiveness is desirable in elderly patients with femur fracture. Serum cytokines have been considered as a possible marker but with inconclusive evidence. The present study aimed to assess the systemic inflammatory response to surgical trauma through the serum levels of several cytokines (IL1\u03b2, IL6, IL8, and IL-10), inflammatory markers (c reactive protein\u2014CRP), and muscular damage markers (creatinkinase\u2014CK) at different time intervals in a consecutive series of patients affected by pertrochanteric fractures (PFs) and treated by two different surgical devices (intramedullary nailing (IM) vs. dynamic hip screw plate\u2014DHS). Methods: A total of 60 consecutive patients (45 female and 15 male, mean age 85.6 years) with PFs (AO31A1.2-2.2) were randomly assigned to two groups according to the surgical procedure used (IM vs. DHS). Specimens of venous blood were collected 1 h preoperatively and at 24, 48, and 72 h postoperatively. Commercial ELISA kits were used. Results: In the adjusted linear mixed model, the serum levels of IL-1\u03b2, IL-8, IL-10, CRP, and CK revealed no statistically significant correlation with the type of surgical intervention performed. A significant (p &lt; 0.001) correlation was found for IL-6 values in patients undergoing IM, showing higher serum values than patients receiving DHSs in all postoperative blood sample collections. Conclusions: The results of this study reveal that the use of DHSs may have less biological impact than IM in frail elderly due to a more limited secretion of IL-6 cytokines deriving from the preservation of the femoral medullary canal, representing a possible guide for the choice of the surgical device.<\/jats:p>","DOI":"10.3390\/jcm14061825","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T05:46:52Z","timestamp":1741585612000},"page":"1825","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cephalomedullary Nailing vs. Dynamic Hip Screw for the Treatment of Pertrochanteric Fractures: The Role of Cytokines in the Prediction of Surgical Invasiveness"],"prefix":"10.3390","volume":"14","author":[{"given":"Armando","family":"Del Prete","sequence":"first","affiliation":[{"name":"Azienda Ospedaliero-Universitaria Careggi, Orthopedic Clinic, University of Florence, Largo Palagi, 1, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2208-3623","authenticated-orcid":false,"given":"Pasquale","family":"Sessa","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense 83, 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferdinando","family":"Del Prete","sequence":"additional","affiliation":[{"name":"Departement of Surgery, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Via Torregalli 3, 50143 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Carulli","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero-Universitaria Careggi, Orthopedic Clinic, University of Florence, Largo Palagi, 1, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Sani","sequence":"additional","affiliation":[{"name":"Departement of Surgery, Azienda USL Toscana Centro, Ospedale Santa Maria Annunziata, Via Antella, 58, Ponte a Niccheri, Bagno a Ripoli, 50012 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariangela","family":"Manfredi","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Department of Immunologia e Allergologia, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Via Torregalli 3, 50143 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0010-7532","authenticated-orcid":false,"given":"Roberto","family":"Civinini","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero-Universitaria Careggi, Orthopedic Clinic, University of Florence, Largo Palagi, 1, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s00068-022-01953-8","article-title":"Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures","volume":"48","author":"Becker","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101824","DOI":"10.1016\/j.jcot.2022.101824","article-title":"Outcomes of minimally invasive osteosynthesis of intertrochanteric fractures with dynamic hip screw: A prospective case series","volume":"27","author":"Shams","year":"2022","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_3","first-page":"505","article-title":"Minimally Invasive Percutaneous Plate Osteosynthesis technique combined with locking compression plates guided by C-Arm X-Ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications","volume":"38","author":"Zhang","year":"2022","journal-title":"Pak. J. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1461638","DOI":"10.1155\/2021\/1461638","article-title":"Interleukin-6 versus Common Inflammatory Biomarkers for Diagnosing Fracture-Related Infection: Utility and Potential Influencing Factors","volume":"2021","author":"Zhao","year":"2021","journal-title":"J. Immunol. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1002\/jor.25116","article-title":"Sex differences in systemic bone and muscle loss following femur fracture in mice","volume":"40","author":"Osipov","year":"2022","journal-title":"J. Orthop. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/0885066610384188","article-title":"Interleukin-6 in surgery, trauma, and critical care part II: Clinical implications","volume":"26","author":"Jawa","year":"2011","journal-title":"J. Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/01.CCM.0000150025.79100.7D","article-title":"Extremely high interleukin-6 blood levels and out-come in the critically ill are associated with tumor necrosis factor- and interleukin-1-related gene polymorphisms","volume":"33","author":"Watanabe","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/01.shk.0000148057.20010.cf","article-title":"Analysis of systemic interleukin-11 after major trauma","volume":"23","author":"Schinkel","year":"2005","journal-title":"Shock"},{"key":"ref_9","first-page":"1374","article-title":"Th1- and Th2-type cytokines in plasma after major trauma","volume":"65","author":"Heizmann","year":"2008","journal-title":"J. Trauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/00003086-200208000-00024","article-title":"A randomized study of the compression hip screw and Gamma nail in 426 fractures","volume":"401","author":"Ahrengart","year":"2002","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1186\/s13018-022-03189-z","article-title":"Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: A systematic review and meta-analysis of randomized trials","volume":"17","author":"Xu","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1302\/0301-620X.87B1.15249","article-title":"Pertrochanteric femoral fractures treated with a dynamic hip crew or a proximal femoral nail. A randomised study comparing post-operative rehabilitation","volume":"87","author":"Pajarinen","year":"2005","journal-title":"J. Bone Joint. Surg. Br."},{"key":"ref_13","first-page":"40","article-title":"A comparison of two fixation methods for femoral trochanteric fractures: A new generation intramedullary system vs. sliding hip screw","volume":"14","author":"Carulli","year":"2017","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_14","first-page":"CD000093","article-title":"Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults","volume":"1","author":"Lewis","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.injury.2020.02.069","article-title":"What should be filled in the blank of 31A2.1 in AO\/OTA-2018 classification","volume":"51","author":"Song","year":"2020","journal-title":"Injury"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e20202590","DOI":"10.1590\/0100-6991e-20202590","article-title":"Description of a minimally invasive technique with a modified instrument for the osteosynthesis of proximal femoral fractures using the standard DHS and case series","volume":"47","author":"Irigoyen","year":"2020","journal-title":"Rev. Col. Bras. Cir."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jneuroim.2008.02.005","article-title":"IL-6 regulates MCP-1, ICAM-1 and IL-6 expression in human myoblasts","volume":"196","author":"Marino","year":"2008","journal-title":"J. Neuroimmunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s10195-012-0199-6","article-title":"Quantification of surgical trauma: Comparison of conventional and minimally invasive surgical techniques for pertrochanteric fracture surgery based on markers of inflammation (interleukins)","volume":"13","author":"Nizegorodcew","year":"2012","journal-title":"J. Orthop. Traumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.injury.2010.09.008","article-title":"Comparison of soft-tissue serum markers in stable intertrochanteric fracture: Dynamic hip screw versus proximal femoral nail\u2014A preliminary study","volume":"42","author":"Hong","year":"2011","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000343","DOI":"10.1136\/tsaco-2019-000343","article-title":"Early increase in anti-inflammatory biomarkers is associated with the development of multiple organ dysfunction syndrome in severely injured trauma patients","volume":"4","author":"Kleinveld","year":"2019","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Brown, M., Worrell, C., and Pariante, C.M. (2021). Inflammation and early life stress: An updated review of childhood trauma and inflammatory markers in adulthood. Pharmacol. Biochem. Behav., 211.","DOI":"10.1016\/j.pbb.2021.173291"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12979-020-00177-x","article-title":"\u201cInflammaging\u201d and bone in the OsteoLaus cohort","volume":"17","author":"Fischer","year":"2020","journal-title":"Immun. Ageing"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tylicka, M., Guszczyn, T., Maksimowicz, M., Kami\u0144ska, J., Matuszczak, E., Karpi\u0144ska, M., and Koper-Lenkiewicz, O.M. (2021). The Concentration of Selected Inflammatory Cytokines (IL-6, IL-8, CXCL5, IL-33) and Damage-Associated Molecular Patterns (HMGB-1, HSP-70) Released in an Early Response to Distal Forearm Fracture and the Performed Closed Reduction With Kirschner Wire Fixation in Children. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.749667"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1136\/rapm-2018-000023","article-title":"Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: A randomized controlled trial","volume":"44","author":"Kristek","year":"2019","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1111\/j.1532-5415.2008.01851.x","article-title":"Time-course of cytokines during delirium in elderly patients with hip fractures","volume":"56","author":"Korevaar","year":"2008","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"644","DOI":"10.29271\/jcpsp.2019.07.644","article-title":"Comparison of Proximal Femoral Nail Antirotation and Dynamic Hip Screw Internal Fixation on Serum Markers in Elderly Patients with Intertrochanteric Fractures","volume":"29","author":"Wang","year":"2019","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Yue, Y., Shang, C., Dong, H., and Meng, K. (2019). Interleukin-1 in cerebrospinal fluid for evaluating the neurological outcome in traumatic brain injury. Biosci. Rep., 39.","DOI":"10.1042\/BSR20181966"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kyriakoulis, K.G., Kollias, A., Poulakou, G., Kyriakoulis, I.G., Trontzas, I.P., Charpidou, A., and Syrigos, K. (2021). The Effect of Anakinra in Hospitalized Patients with COVID-19: An Updated Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194462"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"162","DOI":"10.2174\/1573397116666201216164013","article-title":"Biomarker Approach Towards Rheumatoid Arthritis Treatment","volume":"17","author":"Malhotra","year":"2021","journal-title":"Curr. Rheumatol. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1825\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:49:24Z","timestamp":1760028564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/1825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,8]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14061825"],"URL":"https:\/\/doi.org\/10.3390\/jcm14061825","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,8]]}}}