Teriparatide as an Effective Nonsurgical Treatment for a Patient with Basicervical Peritrochanteric Fracture Nonunion—A Case Report

Abstract

The nonunion rate of surgically treated basicervical peritrochanteric fractures has been reported to be as high as 9%. Due to the high 1-year mortality rate following revision surgery, finding an effective nonsurgical treatment option is of interest. Over the last decade, numerous reports have been published that have suggested teriparatide as an effective treatment for certain types of fracture nonunion. However, the literature focused on teriparatide treatment for proximal femoral fracture nonunion is scanty. A 70-year-old man suffering from a left hip basicervical peritrochanteric fracture received cephalomedullary nail fixation. Nine months after the surgery, the patient still complained of left hip pain referring to the medial thigh with an antalgic limping gait. No sign of healing was noted for more than a consecutive 3 months of follow-up. Fracture nonunion was diagnosed and further confirmed by the computed tomography (CT). The patient preferred nonsurgical treatment after thorough discussion. He then received 4 months of subcutaneous teriparatide injections, 20 mcg daily. After less than 4 months of teriparatide treatment, a follow-up CT confirmed fracture union and the patient’s pain subsided. The patient also tolerated independent ambulation afterward. Teriparatide has been reported to be an effective treatment for certain types of fracture nonunion. Our case goes a step further to expand its possible application for basicervical peritrochanteric fracture nonunion. However, further larger scale studies are needed to confirm its efficacy.

Extracorporeal shock wave treatment for post‑surgical fracture nonunion: Insight into its mechanism, efficacy, safety and prognostic factors (Review)

“…The aforementioned surgical treatment (including external, internal or intramedullary fixation, casting, plaster cast, bone graft and autograft) is regarded as the gold standard for the treatment of patients with PSFN ( 7-9 ). Therefore, some studies have also compared the efficacy of ESWT with that of surgical treatment in patients with PSFN ( 14 , 16 , 54 ).…”

“…Furthermore, it may be associated with an increased risk of death (3)(4)(5)(6). Currently, the most commonly used treatment modalities for patients with PSFN include drug therapy (such as skeleton growth factor and teriparatide) and surgical therapy (autogenous bone grafting and internal fixation surgery), with surgical therapy being regarded as the gold standard (7)(8)(9). Although the union rate is as high as 70.4-89.2% (reported in different countries during 2011-2021) after surgical intervention, a non-negligible proportion of patients with PSFN still face post-surgical complications due to its invasiveness (10)(11)(12).…”