ASSOCIATION OF BIOCHEMICAL AND PHYSIOLOGICAL FACTORS WITH FRACTURE HEALING OUTCOMES: AN OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL IN PAKISTAN
Main Article Content
Keywords
Fracture healing, Delayed union, Biochemical markers, Physiological factors, Vitamin D, Oxidative stress, Bone regeneration
Abstract
Background: Fracture healing is a complex physiological process influenced by biochemical, physiological, and clinical factors. Early identification of patients at risk for delayed union is critical for optimizing outcomes, particularly in resource-limited settings. This study aimed to evaluate the relationship between key biochemical markers, physiological parameters, and fracture healing status in patients treated at a tertiary care hospital in Pakistan.
Methods: A hospital-based observational analytical study was conducted at the Department of Orthopaedics and Biochemistry Laboratory, Ayub Medical Complex, Abbottabad, from January 2023 to June 2024. A total of 120 patients with fresh fractures were enrolled using convenience sampling. Clinical, radiological, biochemical, and physiological assessments were performed. Fracture healing was classified as union or delayed union based on clinical and radiographic follow-up at 6 and 12 weeks. Biochemical parameters included serum calcium, phosphate, alkaline phosphatase (ALP), vitamin D, C-reactive protein (CRP), malondialdehyde (MDA), and superoxide dismutase (SOD). Physiological variables included age, BMI, nutritional status, limb perfusion, comorbidities, and mobility indices.
Results: Delayed union occurred more frequently in older patients, those with higher BMI, smokers, and patients with comorbidities such as diabetes (p < 0.01). Biochemical analysis revealed significantly lower serum calcium, phosphate, ALP, and vitamin D levels, along with higher CRP and MDA and lower SOD in the delayed union group compared to the union group (p < 0.001). Physiologically, poor nutritional status, reduced limb perfusion, lower mobility index, and delayed radiographic callus formation were associated with impaired healing (p < 0.001).
Conclusion: Fracture healing is influenced by a combination of biochemical and physiological factors. Early evaluation of these markers, along with clinical and radiographic assessment, can help identify patients at risk for delayed union, allowing timely interventions and personalized management. Integrating nutritional, lifestyle, and systemic health strategies into fracture care may improve healing outcomes, particularly in resource-limited populations.
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Syed Usman Shah
Assistant Professor, Orthopaedic Department, Ayub Medical College, Abbottabad
Ghazala Rasool
MBBS, FCPS, Assistant Professor, College of Medicine, Northern Border University, Arar
Madeeha Jadoon
MBBS, MPhil biochemistry, CHPE, Associate professor, Head of Biochemistry, Women Dental College Abbottabad
Abid ur Rehman
FCPS, Assistant Professor, Orthopaedics, Ayub Medical College, Abbottabad, PAK
Bilal Karim
Assistant Professor Biochemistry, Islamabad Medical and Dental College, Islamabad
Rehana Rasool
MBBS, MPH, Associate Professor, Department of Community Medicine, Abbottabad International Medical College, Abbottabad
