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Evaluation of Serum Alkaline Phosphatase as a Biomarker of Healing Process Progression of Simple Diaphyseal Fractures in Adult Patients

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Author Affiliations

  • 11Department of Orthopaedics, King George's Medical University, Lucknow-226003, UP, INDIA
  • 2 Department of Biochemistry, King George's Medical University, Lucknow-226003, UP, INDIA

Int. Res. J. Biological Sci., Volume 2, Issue (2), Pages 40-43, February,10 (2013)

Abstract

In day to day practice, progression of bone healing is assessed mainly by clinico-radiological parameters. Furthermore, clinicians are unable to identify the delayed and nonunions early, and even advanced imaging techniques may not be helpful in these cases; hereby increasing the suffering period of the patients. Serum biomarkers, such as alkaline phosphatase (ALP) suggestive of bone formation, may be clinically useful in evaluating the progress of fracture healing. Changes in serum ALP levels were noted at definitive intervals in 95 adult patients (enrolled as per inclusion/exclusion criterion) with simple traumatic diaphyseal fractures of both bones of leg. Regular follow up of these patients was done till either bone union was completed or maximum up to the end of 09 month. The changes in serum ALP levels were recorded and correlated with the clinico-radiological progression of fracture healing in these patients.Depending on the clinico-radiological parameters of progression of fracture healing, all 95 patients were allocated into 02 groups by the end of active follow up; Group A (n = 69): clinico-radiological union achieved before or by the end of 06 months; and Group B (n = 26): clinico-radiological union not completed by the end of 06 months. The Group B was further subdivided into B1 (n= 18): clinico-radiological healing not completed by 06 months but completed by the end of 09 months; and B2 (n= 08): clinico-radiological healing not achieved even by the end of 09 months - Non-union. At the time of admission, mean serum ALP levels remained within normal limits in all included patients. Mean serum ALP levels followed the same pattern in group A and B, reaching a maximum level at post trauma 3rd week. But the mean levels of serum ALPat every selected interval was significantly higher in group A than group B. In Group A, serum ALP levels returned to normal values by complete union achieved (mean healing occurred at 19.2 weeks), where as in group B values remained elevated even by the end of 06 months (mean time of union 28.5 weeks). In Group B2, mean serum ALP level remained within normal limits throughout the followup. So, the determination of serum ALP levels during fracture healing could be an additional tool in predicting fractures at risk of delayed / nonunion of simple diaphyseal fractures, aiding the clinician to prefer the early appropriate intervention at appropriate period.

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