Effect of immobilization on urine calcium excretion in orthopedic patients with pelvic fracture treated by skin traction

Abstract

Objectives: To determine the effects on urine calcium excretion of immobilization by skin traction in patients with pelvic fracture. Methods: In a prospective study, a consecutive series of patients with pelvic fracture treated by skin traction were enrolled. Serum (calcium, phosphorous, alkaline phosphatase, sodium, potassium, uric acid, BUN, creatinine) and fasting urine calcium, creatinine, sodium, potassium and uric acid were checked within 48 hours of hospitalization and at 7, 14 and 21 days of immobilization and then after 3 months of mobilization. Trends in changes of variables were recorded. Results: Fifty five patients were enrolled in this study; they were 45 (81.8%) males and 10 (18.2%) females with a mean age 19.4 ± 12.7 years. We found that serum levels of calcium (p = 0.004), phosphorous (p = 0.047) and alkaline phosphatase (p = 0.001) increased significantly during the 3 weeks of immobilization. In the same way, urine calcium/urine creatinine ratio increased significantly in the study period (p = 0.004). No symptomatic renal stone formation was observed during the study period. Conclusions: Immobilization even in short term causes hypercalciuria in orthopedic patients. Although it is transient and improves with subsequent mobilization, it is needed to be considered specifically by the team caring for this group of patients. immobilized (12,13). Also the effect of immobilization on hypercalciuria and hypercalcemia at intermediate term has been studied (14). There are only few reports (mostly case reports) regarding the hypercalciuria in patients who are immobilized temporarily due to orthopedic fractures (15)(16)(17)(18)(19)(20). In this study, we have investigated the effect of short term immobilization on urinary calcium excretion and also on serum calcium and parathormone in patients who are immobilized with skin or skeletal traction for a pelvic fracture in orthopedic wards. PATIENTS AND METHOD Study populationThis was a prospective cross-sectional study being performed during a 1-year period from 2012 to 2013 in Chamran and Nemazi hospitals, both tertiary orthopedics healthcare centers affiliated with Shiraz University of Medical Sciences. The study protocol was approved by institutional review board (IRB) and ethics committee of Shiraz University of Medical Sciences. All the recruited patients provided their informed written consents before inclusion in the study. We consecutively included all the patients younger than 40 years of age with traumatic pelvic fractures who underwent skin traction and were immobilized. The age limit of 40 was selected to lower the risk of interaction of natural process of resorption induced by aging. Patients with metabolic bone disease, patients with primary or metastatic bone tumor, patients on steroid, calcium or vitamin D supplements, and patients with abnormal baseline serum or urinary calcium level were excluded from the study. We also excluded those patients who were lost at follow-up during the initial 3 weeks of the study, those with renal insufficiency...

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