From the Guidelines
A metabolic workup for nonunion of clavicle fracture is essential to identify underlying metabolic causes, and it should include comprehensive laboratory tests, such as complete blood count, comprehensive metabolic panel, and specific endocrine testing, as recommended by recent clinical practice guidelines 1. When evaluating a patient with nonunion of a clavicle fracture, it is crucial to consider the potential metabolic causes that may be hindering the healing process.
- Basic blood work should include:
- Complete blood count
- Comprehensive metabolic panel
- Calcium, phosphorus, magnesium, alkaline phosphatase, and vitamin D levels (25-hydroxyvitamin D)
- Specific endocrine testing should include:
- Parathyroid hormone (PTH)
- Thyroid function tests (TSH, free T4)
- Testosterone levels for men
- Bone turnover markers, such as N-telopeptide and bone-specific alkaline phosphatase, can provide valuable insights into bone metabolism.
- Inflammatory markers like ESR and CRP should be tested to rule out infection.
- A nutritional assessment, including serum albumin, prealbumin, vitamin B12, and folate levels, is also necessary.
- In cases where metabolic bone disease is suspected, a DEXA scan for bone mineral density is recommended, as suggested by the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. This comprehensive workup is vital because metabolic abnormalities, such as vitamin D deficiency, hyperparathyroidism, thyroid disorders, and nutritional deficiencies, can significantly impair bone healing, and identifying and treating these underlying conditions is crucial for successful management of clavicle nonunion, as they may compromise the body's ability to form new bone and integrate any surgical fixation that might be required.
From the Research
Metabolic Workup for Nonunion of Clavicle Fracture
- The management of nonunion in clavicle fractures can be challenging and often requires assessment and treatment of multiple factors, including biological, mechanical, patient, and injury factors 2.
- Metabolic disorders are one of the factors that can contribute to nonunion, and a metabolic workup may be necessary to diagnose and treat the underlying condition 2.
- The diagnosis of nonunion of the clavicle can be made by a thorough medical history, clinical examination, and imaging procedures, including X-ray images and computed tomography (CT) scans 3.
- The treatment of nonunion of the clavicle depends on various factors, including the presence of symptoms, the location and type of fracture, and the patient's overall health status 4, 5, 3.
- Surgical interventions, such as open reduction and internal fixation with plates and screws, may be necessary to restore the vitality, bone length, and stability of the clavicle 4, 5, 3.
- Autogenous bone material, allogeneic substitute material, and vascularized grafts may be used to treat bony defects in nonunion of the clavicle 3.
- The risk of nonunion following nonoperative treatment of a clavicular fracture can be estimated based on factors such as age, gender, displacement of the fracture, and the presence of comminution 6.