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Different Kinetics of Bone Markers in Normal and Delayed Fracture Healing of Long Bones, Markus Herrmann, 1 Daniela Klitscher, 1 Thomas Georg, 2 Johannes Frank, 3 Ingo Marzi, 3 and Wolfgang Herrmann1 * 1 Department of Clinical Chemistry, University Hospital of the Saarland, D-66421 Homburg Saar, Germany; 2 Institute of Medical Biometrics, Epidemiology and Medical Informatics, University of the Saarland, D-66421 Homburg Saar, Germany; 3 Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, 60590 Frankfurt Main, Germany; * address correspondence to this author at: Department of Clinical Chemistry Central Laboratory, University Hospital of the Saarland, D-66421 Homburg Saar, Germany; fax 49-6841-1623109, e-mail kchwher uniklinik-saarland ; No clinical tests can predict delayed fracture healing. Early knowledge about the individual prognosis of a fracture could help to prevent severe complications e.g., pseudoarthrosis ; , and enable the physician to modify therapy. Plain radiography remains the standard method to monitor fracture healing, but it documents delayed healing only late in the course. Biochemical bone markers might provide earlier information. Osteocalcin OC ; and bone alkaline phosphatase ALP ; , both markers of bone formation, as well as serum type I collagen C-terminal telopeptide -CTx ; , a marker of bone degradation, are used mainly to monitor bone-consuming diseases and antiresorptive therapies 19 ; . Few studies have analyzed the behavior of these markers after fracture. We evaluated their ability to distinguish patients with normal and delayed fracture healing before radiologic evidence of delay is available. We investigated 14 patients with a traumatic crural n 13 ; or femoral n 1 ; shaft fracture Table 1 ; . All patients underwent operative therapy and were monitored for 1 year. No patient suffered from diseases or had been administered medication known to interfere with bone metabolism. Blood samples for measurement of OC, bone ALP, and -CTx were taken within 24 h of fracture and after 7, 14, 28, and 365 days. Serum was separated from whole blood and stored at 20 C until measurement. We also evaluated a clinical score of fracture healing. At the end of the study, patients were classified as having normal or delayed fracture healing. The rate of healing was considered normal if the fracture healed completely after 6 months score 4 ; and score 2 was reached on day 60. Otherwise, fracture healing was classified as delayed. The clinical score was defined as follows: 0 ; , no weight bearing, strong inflammation, pain at rest; 1 ; , mobilization with crutches, partial weight bearing less than.
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1. Pindyck J, Waldman A, Zang E, Oleszko W, Lowy M, Bianco C: Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Evidence of volunteer blood donor cooperation. Transfusion 1985, 25: 3-9 Perkins HA, Samson S, Busch MP: How well has self-exclusion worked? Transfusion 1988, 28: 601-602 Petersen LR, Doll LS, White CR, Johnson E, Williams A: HIV Blood Donors Study Group. Heterosexually acquired human immunodeficiency virus infection and the United States blood supply: considerations for screening of potential blood donors. Transfusion 1993, 33: 552-557 Lewis WF, Dodd RY: Trends in prevalence of HIV infection among U.S. blood donors. Transfusion 1992, 32 S ; : 56S Glynn SA, Kleinman SH, Schreiber GB, Busch MP, Wright DJ, Smith JW, Nass CC, Williams AE: Trends in incidence and prevalence of major transfusion-transmissible viral infections in US blood donors, 1991 to 1996. JAMA 2000, 284: 229-235 Belcher LO, Chandler LK, Gilcher RO: Confidential unit exclusion is it effective? Transfusion 1989, 29 S ; : 76S Chiavetta JA, Nusbacher J, Wall A: Donor self-exclusion patterns and human immunodeficiency virus antibody test results over a twelve-month period. Transfusion 1989, 29: 81-83 Doll LS, Petersen LR, White CR, Ward JW, and the HIV Blood Donor Study Group: Human immunodeficiency virus type 1-infected blood donors: behavioral characteristics and reasons for donation. The HIV Blood Donor Study Group. Transfusion 1991, 31: 704-709 Petersen LR, Doll LS, and the HIV Blood Donor Study Group: Human immunodeficiency virus type 1-infected blood donors: epidemiologic, laboratory, and donation characteristics. Transfusion 1991, 31: 698-703 Busch MP: HIV, HBV, and HCV: new developments related to transfusion safety. Vox Sang 2000, 78: 253-256 Busch MP, Kleinman SH: Nucleic acid amplification testing of blood donors for transfusion-transmitted infectious diseases. Transfusion 2000, 40: 143-159 Mayo DJ, Rose AM, Matchett SE, Hoppe PA, Solomon JM, McCurdy KK: Screening potential blood donors at risk for human immunodeficiency virus. Transfusion 1991, 31: 466-474 Gimble JG, Friedman LI: Effects of oral donor questioning about high-risk behaviors for human immunodeficiency virus infection. Transfusion 1992, 32: 446-449 Lessler JT, O'Reilly JM: Mode of interview and reporting of sensitive issues: design and implementation of audio computerassisted self-interviewing. NIDA Res Monogr 1997, 167: 366-382 Kissinger P, Rice J, Farley T, Trim S, Jewitt K, Margavio V, Martin DH: Application of computer-assisted interviews to sexual behavior research. J Epidemiol 1999, 149: 950-954 Metzger DS, Koblin B, Turner C, Navaline H, Valenti F, Holte S, Gross M, Sheon A, Miller H, Cooley P, et al: Randomized controlled trial of the audio computer-assisted self-interviewing utility and acceptability in longitudinal studies. J Epidemiol 2000, 152: 99-106 Newman JC, Des Jarlais DC, Turner CF, Gribble J, Cooley P, Paone D: The differential effects of face-to-face and computer interview modes. J Public Health 2002, 92: 294-297 Watanabe KK, Zuck T, Schreiber GB, Biswas B, Williams AE: Computerized donor screening strategies: perceived advantages and disadvantages among blood donors. Transfusion 2000, 40 suppl ; : 4S Zuck TF, Cumming PD, Wallace EL: Computer-assisted audiovisual health history self-interviewing. Results of the pilot study of the Hoxworth Quality Donor System. Transfusion 2001, 41: 1469-1474, because generic for hyzaar.
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