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This study involved 15 patients who were undergoing extremity lengthening by callus distraction. Blood samples and radiographs of the callus distraction segment were obtained before surgery, every 2 weeks during the distraction phase, and every 4 weeks between the end of distraction and removal of the fixator. A digital radiograph analysis system was used to determine the radiographic density of the callus distraction segments. In addition, the serum parameters osteocalcin, bone-specific alkaline phosphatase, and C-terminal procollagen peptide (PICP) were evaluated. The radiographic density was constant during the distraction phase, but increased logarithmically during the consolidation period. Similar kinetics were observed for osteocalcin, with an average coefficient of correlation between these two parameters of 0.66+/-0.15. PICP levels rose rapidly after surgery and increased further during the consolidation period. Serum levels of bone-specific alkaline phosphatase were not uniform between patients, and there was no correlation to the kinetics of radiographic density or the other serum parameters. The similarity between radiographic density and osteocalcin kinetics, as well as the rapid postoperative increase in PICP, imply that further information may be obtained about osteoneogenesis from the study of these two serum parameters.

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