Correlation between Biochemical Parameters and Radiographic Healing Score in Tibial Fractures

Fracture healing is a complex biological process influenced by systemic biochemical factors that regulate bone formation and remodeling. Evaluating the association between biochemical markers and radiographic evidence of union may enhance understanding of fracture repair and help predict healing outcomes.

This prospective observational study included 63 adult patients with tibial shaft fractures managed either surgically or conservatively. Serial assessments of serum calcium, phosphorus, alkaline phosphatase (ALP), Vitamin D, and parathyroid hormone (PTH) were performed at baseline, 6, 12, and 24 weeks. Radiographic healing was evaluated at corresponding intervals using the Radiographic Union Score for Tibial fractures (RUST). Correlation between biochemical parameters and RUST scores was analyzed using Pearson's correlation coefficient.

Most participants were males (74.6%), with road traffic accidents as the predominant cause of injury. Progressive improvement was observed in calcium, phosphorus, ALP, and Vitamin D levels during follow-up, while PTH showed a gradual decline. The mean RUST score increased steadily from early to late follow-ups, indicating continuous radiographic healing. At 24 weeks, ALP demonstrated the strongest positive correlation with RUST (r = 0.61, P < 0.001), followed by Vitamin D (r = 0.46, P < 0.001), phosphorus (r = 0.42, P = 0.001), and calcium (r = 0.38, P = 0.002). PTH showed a weak negative correlation (r = -0.33, P = 0.008).

Serum biochemical parameters, particularly ALP and Vitamin D, reflect the biological progression of fracture healing and correlate significantly with radiographic union. Routine biochemical monitoring, in conjunction with radiographic evaluation, can serve as a valuable adjunct in assessing the healing potential of tibial fractures.