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
