Nitric oxide (NO) is a free radical of physiological signifi cance. The changes in the production of NO during the fracture healing process are not well known. This clinical prospective study was planned to determine these changes in patients with fractured long bone(s), who underwent surgery in the 3rd week after fracture. The patients were divided into two groups: 20 patients with an isolated femoral fracture and 20 patients with multiple fractures, including a femoral fracture. Venous blood was drawn from the healthy volunteers (n = 20) once, and from the patients seven times during 21 days after fracture. NO level was measured as nitrite in each serum sample. The serum NO levels at all measurements of the patients were signifi cantly higher than those of the control subjects. The timedependent changes in the NO levels were similar in both patient groups. The serum NO levels were highest in the fi rst 6 hrs, and then decreased to the lowest level on the 3rd day. Subsequently, there was an increasing trend on the 5th, 7th and 14th days. At all times of the measurements, the NO levels were higher in patients with multiple fractures than in those with the femoral fracture, with the signifi cant difference observed at the 6 hrs and on the 7th day. The NO levels were decreased on the 21st day after surgery. The present study suggests that NO production may be increased in considerable amounts during the fi rst 2 weeks of fracture healing, particularly in the fi rst 6 hrs.human; bone; fracture; blood; nitric oxide
© 2007 Tohoku University Medical PressNitric oxide (NO) is a physiological free radical, synthesized from the amino acid L-arginine by the 3 NO synthase (NOS) isoforms; neuronal NOS (nNOS), endothelial NOS (eNOS) and inducible NOS (iNOS). It functions in vascular regulation, host immune defense, neurotransmission, and other systems. While some diseases, like vascular dysfunctions, impair NO production, some diseases, like septic schock, cerebral infarction, diabetes mellitus and neurodegenerative disorders, augment NO production (Mori and Gotoh 2004). It is not clear how NO affects bone cells. Some studies show that NO has a biphasic effect on bone cell activity. It has been stated that moderate concentrations of NO produced by eNOS in the bone is necessary for normal osteoblast growth and fracture healing (Ralston 1997;Corbett et al. 1999). However, it was suggested that high concentrations of NO produced by cytokine-induced iNOS activity may inhibit the