Role of teriparatide in fracture healing: A prospective study

Abstract

Background: Proximal Femoral Nail (PFN) provides tangible evidence for its usage in unstable pertrochanteric fractures. There are a veritable number of references which show that PFN by virtue of its intramedullary fixation reduces the tensile strain thereby mitigating implant failure. Ours is a prospective study done on 50 subjects to assess the outcome of PFN usage in unstable pertrochanteric fractures. Methodology: 50 patients with Jensen Michaelsen type III, IV, V intertrochanteric and reverse oblique fractures were included in the study. The reduction obtained intra operatively was assessed using the modified criteria of Baumgaertner. Follow up evaluations were done at 6, 12, 24 and 52 weeks thereafter. Clinical evaluation was done using the Mobility score of Parker and Palmer. Radiographic parameters like fracture union, screw slide and degree of varus collapse were also assessed. Statistical analysis was provided by Friedman test. Results: Jensen Michaelsen type IV was the most common pattern observed (44%). The mean pre-injury parker score was 8.4. Patients with reverse oblique fracture morphology, type V fractures and patients with osteoporosis were treated with Long PFN (19 cases). The mean operating time was 92 minutes (range 60 -180), and the mean blood loss during the surgery was 145 ml (range 100ml -320 ml). The reduction was good in 40 patients (80%) and acceptable in the rest. The average time taken for fracture union was 15 weeks. It was observed that patients reached their preoperative mobility score of Parker and Palmer by 6 months post-surgery which was statistically significant (χ2 = 217.642, p < .001). Discussion: Proximal Femoral Nailing is done through a minimally invasive approach not disturbing the fracture hematoma which is a vital in fracture consolidation. The biomechanics of intramedullary fixation in cases of destabilised medial cortex is optimised by medialization of the fulcrum point and resultant reduction of the bending moment with respect to proximal fixation. Fracture reduction was good in 80% cases and in 10 cases the reduction was acceptable with a mean varus malalignment of 13.2 degrees.The mean intraoperative blood loss of 145 ml in our series compares favourably with previously reported values in the literature. Most of the fractures in our series (66%) united by 12-14 weeks. The mean preoperative mobility score of Parker was 8.4, which was reached by patients on their 6 th postoperative month (p & lt; 0.001). Each period showed statistically significant improvement over the previous period as evident from the rank total of the scores and the critical ratio.

Efficacy and Safety of Teriparatide in Improving Fracture Healing and Callus Formation: A Systematic Review

“…The duration of treatment varied between two to four months, depending on the type of fracture and the time required for radiographic evidence of union. The study found that fractures treated with 20 µg of teriparatide showed early signs of union with significant callus formation, a decrease in the time required for radiographic union, and early rehabilitation of patients in all three groups [36].…”

“…A prospective study done by Saraf et al showed a positive result. The study found that for delayed union fractures, the use of teriparatide was associated with a shorter healing time compared to the group treated with a placebo [36]. Another prospective study done by Kastirr et al also showed a positive result after an average of 4.1 ± 1.5 (two to six) months after PTH treatment.…”

Efficacy of Teriparatide in Comminuted Fracture Healing in Lower Limb: A Retrospective Study

“…Treatment of non-union fractures using teriparatide helps patients to avoid undergoing another surgical procedure and problems associated with auto-grafts such as injury or pain to donor site or neurovascular damage [12]. Side effects include -nausea, headache, and vomiting.…”

“…Local side effects at site of injection include -pain, itching, swelling, and erythema. It can also cause an increase in serum levels of uric acid; hence, it should be prescribed with caution in patients with renal disease impairment [12].…”

“…The mean post-operative time required for healing of fracture was found to decrease in patient treatment with teriparatide when compared to those who did not receive this therapy (i.e., 12.1 and 14.8 weeks, respectively)[10].Yukata et al in 2018 in their study showed that a continuous PTH 1-34 administration or infusion led to a delay in healing of a fracture wound due to delay in maturation of callus[11]. Saraf and Munot in 2017 demonstrated that fractures which were treated with 20 µg dosage of teriparatide demonstrated only signs of union associated with large amount of callus formation with significant reduction in radiographic union and early patient rehabilitation[12]. Bhandari et al in 2016 also reported that only 15% of patients suffering from hip fractures with internal fixation who were administered teriparatide required revision surgery.…”