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Nonunion correlated with metabolic and endocrine abnormalities
An 84% rate of newly detected endocrine abnormalities seen in nonunion fracture study group.
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BOSTON — Investigators here revealed a "staggeringly high" prevalence of metabolic and endocrine abnormalities in a fracture nonunion patient population.
"Some fractures fail to unite despite excellent fixation in a seemingly healthy host with good local biology," said Mark R. Brinker, MD, in a presentation at the 23rd Annual Meeting of the Orthopaedic Trauma Association. "What is going on in these patients?"
Previous reports in the literature have indicated these types of abnormalities in the nonunion of fractures. The factors cited include: vitamin D abnormalities, calcium, growth hormones, parathyroid hormones or hypogonadism, Brinker said.
To further investigate the prevalence of previously undiagnosed endocrine abnormalities in patients with nonunion, Brinker and colleagues from the Texas Orthopedic Hospital in Huston studied a series of 683 consecutive patients with a nonunion. Of those, 37 patients were referred to an endocrinologist for evaluation. These referred patients had either nonunion that occurred despite reduction and stabilization without technical errors or any other etiology; a history of low-injury fractures that led to nonunion in at least one fracture; or a nonunion of a displaced pubic rami or a sacral ala fracture.
"These are patients that we would not normally test," Brinker said.
The testing revealed an overall, newly identified endocrine abnormality rate of 84%, with 68% of the subpopulation showing a vitamin D deficiency.
"Twenty-four of the 37 patients had two or more abnormalities," Brinker said. Other abnormalities indentified included calcium deficiencies, thyroid problems and hypogonadism.
The prevalence of these abnormalities was not related to age, gender or nonunion type, he said.
The patients were treated for their abnormalities and then for the nonunions. Subsequently, 35 of the 37 nonunions healed. "Eight patients healed after their medical treatment for the endocrine abnormality alone without any operative intervention," Brinker said.
"Evaluations for endocrine and metabolic abnormalities in certain patients with nonunion should become the standard of care," he said. "Screening for all patient with nonunion and some patients with fracture may be warranted in the future."
For more information:
- Brinker MR, O'Connor DP, Monla YT, et al. Metabolic and endocrine abnormalities in patients with nonunions: Have we been missing the boat? Paper #15. Presented at the 23rd Annual Meeting of the Orthopaedic Trauma Association. Oct. 18-20, 2007. Boston.