Wound healing will depend on three things:
1. Nutrition of the patient
2. Blood supply
3. Immune status of the patient
About 40% of orthopaedic patients are malnourished. In general, about 60% of elderly patients are malnourished. Fractures of the femur or hip may increase the metabolic demand on the patient by up to 25%. There are certain parameters to look for. Albumin should be more than 3.5 because it indicates a good nutritional status of the patient. The total lymphocyte count should be more than 1500 and this will indicate the immune response of the patient. Hemoglobin should be more than 10, this will indicate the oxygenation of the tissues. The transferrin level should be more than 200, this indicates the condition of the iron and hemoglobin and deals with the oxygenation of the tissues. These are the lab values that you will probably get in a patient that has suspected malnutrition. Up to 50% with low values will have poor wound healing or infection. Elective surgery should be delayed or rescheduled until these values are improved by nutritional support.
What can alert the physician about the nutritional status of the patient? What are the red flags that may indicate that the patient may be malnourished? Ask the patient about weight loss if you have more than 5% of weight loss over the course of one month or more than 10% over the course of six months, then this is a problem that can indicate that the nutritional status of the patient may not be good.
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