Effect of Calcium and Vitamin D Supplementation in Patients with Fracture Nonunions

Abstract

Objective: To study the effects of calcium and vitamin D supplementation in cases of fracture nonunion.

Study design: Non-randomized intervention study.

Place and duration of study: This study was carried out at Combined Military Hospital Gujranwala Cantonment, from October 2010 to October 2011.

Methodology: 14 patients were included. Serum calcium, vitamin D and parathormone (PTH) levels were determined in all of these patients. The patients were divided into 2 main groups. Group 1 was medical where only calcium and vitamin D supplementation was done. Group 2 was surgical which was again divided into two subgroups. In sub-group (A) surgery was supplemented with calcium and vitamin D administration, and second sub-group (B) underwent surgery with no supplementation. Tab Qalsan, 1 OD and tab Bone One 0.5ug was administered as calcium and vitamin D supplementation. Follow up of the cases was done on monthly basis. Calcium and vitamin D supplementation was continued till union of fractures.

Results: In this study males were 85.71%. Mean age was 37.71 years. The mean duration from injury to presentation with nonunion in our study was 11.4 months. Out of 14 patients, 5 cases were managed with calcium and vitamin D3 therapy only. 2 cases underwent operative intervention with calcium and vitamin D3 therapy. 7 cases underwent operative intervention without calcium and vitamin D3 administration. 2 patients had low serum calcium, 6 had low serum vitamin D and 1 had low serum parathyroid hormone level. 95% confidence interval for having a metabolic or endocrine abnormality for patients with nonunion was 26.8% to 73.2% by Adjusted Wald Method. All of the patients achieved bony union. The mean time for union was 6. 4 months.

Conclusion: Vitamin D deficiency was detected in 6 of our patients suffering with long bones nonunion. With oral calcium and vitamin D replenishment, union was achieved. This shows that metabolic supplements do have a role in union of fractures in addition to appropriate surgical intervention.

Key words: Fracture nonunion, bone, hormone, vitamin D