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Teriparatide in Fracture Non-Unions.

Coppola C, Del Buono A, Maffulli N - Transl Med UniSa (2014)

Bottom Line: Teriparatide administration resulted in adequate bone callus over the site of nonunion in all the patients, and clinical and radiographic evidence of sound union.It may induce an angiogenetic response which counteracts the features responsible for development of non-union.Level IV, therapeutic case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Hospital "S. Maria di Loreto Nuovo", Naples, Italy.

ABSTRACT

Background: The use of teriparatide in the management of fracture disorders is poorly documented. This study aims to show that teriparatide administration may improve the healing process in patients with nonunions after open fixation of traumatic fractures of the lower limb.

Methods: Four patients received Teriparatide for management of non-unions after open fixation of traumatic fractures of the lower limb.

Results: Teriparatide administration resulted in adequate bone callus over the site of nonunion in all the patients, and clinical and radiographic evidence of sound union.

Conclusions: The efficacy of teriparatide in delayed or non unions is still unclear. It may induce an angiogenetic response which counteracts the features responsible for development of non-union.

Level of evidence: Level IV, therapeutic case series.

No MeSH data available.


Related in: MedlinePlus

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Mentions: A 36-year-old male healthy swimmer, nonsmoking sustained a Gustilo III 3B fracture16 of the right femur, 33A3.1 according to the AO classification system, in a road accident (Fig 1). He underwent open reduction and mono axial external fixation supplemented by Kirschner wires (Fig 1). At four weeks, after the soft tissues had healed, an external fixator was applied. Imaging two months after surgery showed poor bone apposition in the medial and posterior aspects of the site of fracture (Fig 2). Four months after the initial injury, the distal external fixation pins had loosened and there was delay in healing. The patient underwent open reduction, fixation and stabilization of the fracture with a mono axial fixator supplemented with Allomatrix (Wright Medical Technology, Inc, Arlington, Tenn)17,18. Eleven months after the trauma, despite signs of nonunion at radiographic evaluation, the external fixator was removed, and the patient started to walk in a protected brace. Laboratory investigations, including serum alkaline phosphatase, PTH, calcium, creatinine, and 25 (OH) vitamin D were normal, excluding any metabolic disorder. After 15 months from the original trauma, the patient underwent open reduction and internal fixation with a condylar plate, application of platelet rich plasma and implantation of bone allograft. At 20 months, given the poor bone integration of the graft and the absence of bone callus, the patient started treatment with subctunaneous injection of teriparatide (1 injection of 20 μg daily), calcium and vitamin D. After 9 months of treatment, the 3D CT showed complete integration around the plate and the bone graft, with adequate formation of bone callus at the site of nonunion (Fig 3). The serum levels of alkaline phosphatase, increased during the 9 months of therapy with teriparatide, normalised within 3 months of interruption of teriparatide administration. At follow up 3 and 5 years from the last operation, the nonunion was healed and the patient was satisfied in terms of daily and sport activity. Clinically, a 3.5 cm discrepancy was well tolerated and balanced by wearing a shoe with a raise and an insole.


Teriparatide in Fracture Non-Unions.

Coppola C, Del Buono A, Maffulli N - Transl Med UniSa (2014)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592043&req=5

Mentions: A 36-year-old male healthy swimmer, nonsmoking sustained a Gustilo III 3B fracture16 of the right femur, 33A3.1 according to the AO classification system, in a road accident (Fig 1). He underwent open reduction and mono axial external fixation supplemented by Kirschner wires (Fig 1). At four weeks, after the soft tissues had healed, an external fixator was applied. Imaging two months after surgery showed poor bone apposition in the medial and posterior aspects of the site of fracture (Fig 2). Four months after the initial injury, the distal external fixation pins had loosened and there was delay in healing. The patient underwent open reduction, fixation and stabilization of the fracture with a mono axial fixator supplemented with Allomatrix (Wright Medical Technology, Inc, Arlington, Tenn)17,18. Eleven months after the trauma, despite signs of nonunion at radiographic evaluation, the external fixator was removed, and the patient started to walk in a protected brace. Laboratory investigations, including serum alkaline phosphatase, PTH, calcium, creatinine, and 25 (OH) vitamin D were normal, excluding any metabolic disorder. After 15 months from the original trauma, the patient underwent open reduction and internal fixation with a condylar plate, application of platelet rich plasma and implantation of bone allograft. At 20 months, given the poor bone integration of the graft and the absence of bone callus, the patient started treatment with subctunaneous injection of teriparatide (1 injection of 20 μg daily), calcium and vitamin D. After 9 months of treatment, the 3D CT showed complete integration around the plate and the bone graft, with adequate formation of bone callus at the site of nonunion (Fig 3). The serum levels of alkaline phosphatase, increased during the 9 months of therapy with teriparatide, normalised within 3 months of interruption of teriparatide administration. At follow up 3 and 5 years from the last operation, the nonunion was healed and the patient was satisfied in terms of daily and sport activity. Clinically, a 3.5 cm discrepancy was well tolerated and balanced by wearing a shoe with a raise and an insole.

Bottom Line: Teriparatide administration resulted in adequate bone callus over the site of nonunion in all the patients, and clinical and radiographic evidence of sound union.It may induce an angiogenetic response which counteracts the features responsible for development of non-union.Level IV, therapeutic case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Hospital "S. Maria di Loreto Nuovo", Naples, Italy.

ABSTRACT

Background: The use of teriparatide in the management of fracture disorders is poorly documented. This study aims to show that teriparatide administration may improve the healing process in patients with nonunions after open fixation of traumatic fractures of the lower limb.

Methods: Four patients received Teriparatide for management of non-unions after open fixation of traumatic fractures of the lower limb.

Results: Teriparatide administration resulted in adequate bone callus over the site of nonunion in all the patients, and clinical and radiographic evidence of sound union.

Conclusions: The efficacy of teriparatide in delayed or non unions is still unclear. It may induce an angiogenetic response which counteracts the features responsible for development of non-union.

Level of evidence: Level IV, therapeutic case series.

No MeSH data available.


Related in: MedlinePlus