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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(06): 796-803
DOI: 10.1055/s-0041-1724072
Artigo Original
Trauma

Monitoring the Progress of Treatment in Fracture Non-Union: The Role of Alkaline Phosphatase and Ultrasonography[*]

Article in several languages: português | English
Dhanji S. Chaudhary
1   Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
,
Jayur J. Solanki
1   Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
,
Tarun Verma
1   Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
,
Viswanath H. Chavali 
1   Departamento de Ortopedia, Medical College Baroda e SSG Hospital, Vadodara, Gujarat, Índia
› Author Affiliations Financial Support There was no financial support from public, commercial, or non-profit sources.
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Abstract

Objective To evaluate the role of serum alkaline phosphatase (ALP) and ultrasonography (USG) in monitoring the progress of treatment in diaphyseal non-unions.

Methods This prospective observational cohort study included adult patients with diaphyseal fractures of major long bones previously treated with internal fixation and eventually resulting in non-union. Following the definitive treatment for non-union, the patients were followed-up periodically for six months, and serial monitoring of the levels of ALP and USG were performed along with radiographs (X-rays) to ascertain the status of the union.

Results After an initial rise at seven weeks, ALP levels declined to normal values in fractures which united, whereas they remained high in cases of persistent non-union. Similarly, after an elevation of the vascular resistive index (RI) at around 12 weeks in all the patients, it decreased in cases progressing to union, while it remained persistently high even at 24 weeks in fractures failing to unite. Cases of persistent non-union continued to show hypoechogenic callus at 24 weeks instead of converting into hyperechogenic callus, as observed in cases which progressed to union.

Conclusion Significant changes suggestive of union appeared simultaneously on the X-rays, USG and ALP levels during the follow-up. However, a serial examination of the ALP levels and USG during the follow-up gave a hint of the direction of progress in the healing process of fracture non-union. Their role in monitoring the outcome of non-union is more complimentary than supplementary to the X-rays.

Keywords

bony callus - ultrasonography - alkaline phosphatase

* Study developed at the Department of Orthopedics, Medical College Baroda SSG Hospital, Vadodara, Gujarat, India.




Publication History

Received: 15 July 2020

Accepted: 02 October 2020

Article published online:
07 December 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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