title: Changes in biochemical markers after lower limb fractures.
abstract: BACKGROUND
  The bone remodeling sequence after bone fracture changes the concentrations of biochemical bone markers, but the relationships of fracture size and of healing time to changes in biomarkers are unclear. The present pilot study was undertaken to determine the changes found in serum bone markers after plate osteosynthesis of closed distal tibial and malleolar fractures during a study period of 24 weeks.
  
  
  METHODS
  We measured tatrate-resistant acid phosphatase (TRACP 5b), collagen type I C-terminal telopeptide (ICTP), bone-specific alkaline phosphatase (bone ALP), osteocalcin (OC), procollagen type I C-terminal propeptide (PICP), procollagen type III N-terminal propeptide (PIIINP), and human cartilage glycoprotein 39 (YKL-40) in 20 patients with lower limb fractures (10 malleolar, 10 tibia). A physical examination and radiographs were completed to assess evidence of union.
  
  
  RESULTS
  All malleolar fractures healed within 6 weeks, whereas 2 tibial fractures did not show complete bone healing after 24 weeks. Changes were comparable but more pronounced in the tibia group, and marker concentrations remained increased at the end of study (bone ALP, 86 vs 74 U/L; OC, 14.9 vs 7.7 microg/L; ICTP: 5.6 vs 3.3 microg/L at day 84 after osteosynthesis, P <0.05 in tibia; 80 vs 70 U/L, 8 vs 5.2 microg/L, and 3.5 vs 3.2 microg/L, respectively, in the malleolar fracture group).
  
  
  CONCLUSIONS
  In normal bone healing, changes in bone turnover markers were primarily dependent on the fracture size. Delayed tibia fracture healing may involve a disturbance in bone remodeling.
authors.affiliation: Department of Orthopaedic Surgery, University of Western Australia, Fremantle, Western Australia, Australia.
authors.forename: Karl
authors.initials: K
authors.lastname: Stoffel
authors.forename: Hanna
authors.initials: H
authors.lastname: Engler
authors.forename: Markus
authors.initials: M
authors.lastname: Kuster
authors.forename: Walter
authors.initials: W
authors.lastname: Riesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007869:Leg Injuries / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013978:Tibial Fractures / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers