Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients
Table 1
Recommendation for initial metabolic laboratory evaluation in the setting of fracture nonunion, with associated common abnormalities and underlying disease processes. We recommend CBC, CMP, 25-hydroxyvitamin D, iPTH, and TSH, as well as CRP and ESR to rule out infection. Additional tests may be required and obtained by a treating endocrinologist depending on the initial laboratory screening results.
Laboratory Test
Important Values
Common Nonunion Abnormalities
Associated Diseases or Causes for Abnormal Values
Complete blood count (CBC)
White blood cell (WBC)
Elevated
Infection
Decreased
Immunosufficiency
Sedimentation rate
(ESR)
Elevated
Infection
C-reactive protein
(CRP)
Elevated
Infection
Comprehensive metabolic panel (CMP)
Calcium (Ca)
Decreased
Hypoparathyroidism
Vitamin D deficiency
Renal osteodystrophy
Alkaline phosphatase (ALP)
Elevated
Vitamin D deficiency
Calcium deficiency
Chronic renal failure
Albumin (Alb)
Decreased
Protein deficiency
Glucose (Glu)
Elevated
Diabetes mellitus
Thyroid function panel
Thyroid stimulating hormone (TSH)
Elevated
Hypothyroidism (Low T3, T4)
Decreased
Hyperthyroidism (High T3, T4)
Free T4
Decreased
Hypothyroidism (Low T3, T4)
Elevated
Hyperthyroidism (High T3, T4)
Free T3
Decreased
Hypothyroidism (Low T3, T4)
Elevated
Hyperthyroidism (High T3, T4)
Intact parathyroid hormone (iPTH)
(iPTH)
Elevated
Primary hyperparathyroidism: pituitary adenoma
Secondary hyperparathyroidism: Vitamin D deficiency, Vitamin D resistance
