Bone Healing and Hormonal Bioassay in Patients with Long-Bone Fractures and Concomitant Head Injury

Abstract

Objective: The aim of this study is to investigate healing of fractures in patients with concomitant head injuries and to measure blood hormone levels to elucidate the mechanism of a possible accelerated osteogenesis.

Materials and methods: One hundred and sixty-two patients were included in this study and divided into 3 cohorts: group A with head injuries only (n = 52); group B with head injuries as well as long-bone fractures (n = 50); group C with long-bone fractures only (n = 60). Fracture-healing parameters including time of appearance and thickness of the bridging callus, and blood hormonal assays were measured and compared using Student's t test.

Results: The mean time to healing was significantly lower in cohort B (6.9 ± 2.9 weeks) than C (22.4 ± 8.7 weeks; p = 0.001). The mean thickness of the healing callus was significantly higher in cohort B (26.3 ± 9.7 mm) than C (8.1 ± 5.9 mm; p = 0.002). The mean healing rate was also higher in cohort B (4.5 ± 2.3 mm/week) than C (0.38 ± 0.21 mm/week; p = 0.001). Blood hormonal assays in group B showed higher values of parathyroid hormone and growth hormone than in group C. However, adrenaline and noradrenaline values were lower in group B than in group C at all measured time intervals, and correspondingly leptin was lower in all groups (p = 0.001). Corticosteroid values were normal in group B compared to slightly higher values in group C, also at all measured time intervals.

Conclusion: In this study, healing of fractures in patients with concomitant head injuries was accelerated, thereby indicating an involvement of a combined neurohormonal mechanism.

Fig. 1

Three-dimensional CT scan of both femora with accelerated fracture healing and abundant callus formation 6 weeks after injury in a group B patient with severe head injury.

Fig. 2

Line chart of serum parathyroid hormone values in patient groups A-C during their first 3 weeks of follow-up, with D indicating the normal level in healthy subjects.

Fig. 3

Column chart of serum noradrenaline values in patient groups A-C during their first 3 weeks of follow-up, with D indicating the normal level in healthy subjects.