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ORIGINAL ARTICLE
Year : 2015  |  Volume : 15  |  Issue : 3  |  Page : 269-275

Changes in biochemical markers in blood and urine in case of malunion and nonunion after fracture of long bones


1 Department of Biochemistry, Burdwan Medical College, Burdwan, West Bengal, India
2 Department of Orthopedics, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
3 Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
4 Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Correspondence Address:
Arunima Chaudhuri
Department of Physiology, Burdwan Medical College and Hospital, Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
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DOI: 10.4103/1319-6308.164304

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Background: Biochemical markers provide a dynamic view of the remodeling process of bone. Aims: To monitor biochemical markers in long bone fractures as they reflect the actual status of fracture healing. Materials and Methods: The present study after taking Institutional ethical clearance and informed consent of the subjects. Patients with normal fracture union served as controls (50); Patients with impaired fracture union served as cases. They were further divided into two groups: Fracture nonunion (20) and fracture malunion (30). Serum calcium, serum alkaline phosphatase (ALP), urinary calcium to creatinine ratio, and urinary total and free hydroxyproline were measured. Results: Serum ALP, serum calcium, urinary total and free hydroxyproline, and urinary calcium to creatinine ratio were increased in all patients after fracture. Serum ALP, urinary total and free hydroxyproline decreased after treatment in nonunion patients. Serum ALP reached to lower level of reference interval in this group. But urinary total and free hydroxyproline decreased to less than normal level. Serum calcium increased up to 2 weeks following treatment and then reduced to normal level within 1-month in fracture normal union and malunion groups. Serum calcium reduced at a very slow rate after treatment in nonunion patients and remained within reference interval. Significant differences were found between normal union and nonunion groups in case of serum ALP, urinary total and free hydroxyproline levels after treatment. Significant differences were found between normal union and nonunion groups in serum calcium level after treatment on day 7 and 14. Conclusions: Serial monitoring of biochemical markers of bone turnover reflect the actual status of bone resorption and bone formation, respectively. Thus, they can be used as an adjunct to clinical and radiological evidence of fracture healing.


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