Ferritin Elevation After Leg Fracture
Ferritin levels typically rise within 1 day after surgical trauma and remain elevated for at least 3 days, though the exact duration of elevation following a leg fracture specifically has not been well-characterized in the literature.
Timeline of Ferritin Changes After Trauma
The most relevant evidence comes from a study examining post-operative ferritin changes:
- Ferritin increases significantly within 24 hours of surgical trauma 1
- Peak elevation occurs around day 3 post-operatively 1
- Levels remain elevated at day 3, which was the last observation point in the available study 1
Understanding Ferritin as an Acute Phase Reactant
Ferritin behaves as an acute phase reactant during inflammation and trauma, which is the mechanism behind its elevation after fractures 2. This is critical to understand because:
- The elevation does not represent true iron overload 2
- It reflects the inflammatory response to tissue injury 2
- Concurrent findings typically include decreased plasma iron (hypoferremia) starting within 24 hours 1
- Serum transferrin also decreases significantly after operative trauma 1
Clinical Implications
When evaluating elevated ferritin in the context of recent fracture or surgery, consider it an inflammatory marker rather than evidence of iron overload 2. Key distinguishing features include:
- Inflammatory iron block typically shows abrupt ferritin increase with sudden drop in transferrin saturation 2
- This contrasts with true iron overload where ferritin and transferrin saturation are both elevated 2
Important Caveats
The available evidence only tracked ferritin for 3 days post-operatively 1, so the complete duration of elevation remains uncertain. In clinical practice:
- If ferritin remains elevated beyond the expected acute inflammatory period (likely 1-2 weeks based on typical acute phase response patterns), investigate alternative causes 3, 4
- Ferritin >1000 µg/L warrants further investigation regardless of recent trauma, as this may indicate underlying pathology beyond acute inflammation 4
- In hip fracture patients specifically, persistently elevated ferritin (≥308.5 ng/mL) has been associated with poor outcomes, though this likely reflects overall inflammatory burden rather than the fracture itself 5
Do not initiate iron chelation or therapeutic phlebotomy for transiently elevated ferritin in the post-fracture period, as this represents appropriate physiologic response to trauma rather than pathologic iron accumulation 2.