Correlation of bone-specific alkaline phosphatase level with clinico-radiological signs of fracture healing in tibial shaft fractures
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:107
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Bansal S, Kumar S, Jain
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Introduction: Bone as a living, dynamic tissue undergoes anabolic and catabolic turnover through the action of basic multicellular units of osteoblasts and osteoclasts known as the bone metabolic units (BMU). The processes of modelling and remodeling occur through these basic units and are responsible for important physiological period of growth. They are also activated in fracture healing and can be demonstrated quantitatively by estimation of bone turnover markers (BTMs). Bonespecific alkaline phosphatase (BAP) is a specific marker of osteoblasts and gives a good measure of bone forming activity.
Methodology: A case series to evaluate the changes in BAP levels during healing of isolated closed tibial shaft fracture was conducted including 25 healthy adults of age 18 to 45 years (mean-30 yrs). Normal fracture healing was defined to be 6 months in a tibial shaft fracture. The patients having any systemic condition, disease, and/or drug intake affecting bone turnover were excluded. All the fractures were managed nonoperatively. Follow up was done at every 4 weeks till 6 months of the injury to look for clinico radiological signs of fracture union. Biochemical monitoring was done at the time of injury, 4weeks, and 8 weeks. BAP was measured using an enzyme immunoassay (EIA) in a microtitre strip format utilizing a monoclonal anti-BAP antibody.
Observations and results: All the fractures united. The baseline value of BAP was 16.9±6.94 Units/l and it increased by 40% to a value of 23.8±10.49 Units/l at 4 weeks (p=0.005) and by 71% to a value of 28.9±13.42 U/l at 8 weeks (p= 0.001). Thus, the level increased significantly at both 4 and 8 weeks demonstrating the predominant osteoblastic activity at this stage.
Conclusions and clinical implications: The rise of the marker paralleled the clinic- radiological signs of fracture healing such as absence of mobility at the fracture site and the appearance of callus at fracture site at 8 weeks. Clinico-radiological examination remains the gold standard for assessing fracture healing. But early detection of a slow healing or a non healing fracture is not possible using these methods only. The bone turnover markers are suggested as a non-invasive aid for monitoring fracture healing. Therefore, sustained efforts need to be continued in our endeavour to find a bone turnover marker as a diagnostic or prognostic tool for monitoring bone healing.
|How to Cite this Abstract|
|Bansal S, Kumar S, Jain. Correlation of bone-specific alkaline phosphatase level with clinico-radiological signs of fracture healing in tibial shaft fractures. International Journal of Conference Proceedings 2015;(2015):107|