Treatment of Atypical Fracture of the Ulnar Diaphysis by Open Reduction and Internal Fixation with Teriparatide

Abstract

Atypical fractures commonly arise in the subtrochanteric region or the femoral shaft, whereas those of the upper extremities are rare. Only 15 fractures in 13 patients have been described in the English literature. The management of such fractures has not been established. We describe a patient with an atypical fracture of the ulnar diaphysis, which required revision surgery to achieve the union of the fracture site. Teriparatide together with low-intensity pulsed ultrasound contributed to bone healing. Further studies are needed to determine the optimal strategy for treating atypical fractures of the ulna.

Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

“…Additional treatment included use of bone graft, dual plate, LIPUS, and administration of teriparatide. The outcomes of additional treatment and mean duration of follow-up are summarized in Table 1 [6][7][8][9][10][11][12][13][14][20][21][22]. Details of drilling and decortication are not included in Table 1 owing to the very few reports that described drilling and decortication.…”

“…Atypical fracture of the ulna due to SSBT is a rare entity [ 6 ]; therefore, there is no standardized treatment strategy. In addition, widely variable treatment outcomes have been described in previous reports.…”

“…Reports of atypical fractures in patients receiving long-term bisphosphonates have largely pertained to femoral fractures; there is a paucity of data about atypical fractures at other sites in this setting [5]. Atypical fractures of the upper extremities are rare [6]. On literature search in April 2020, we could identify only 18 reports describing 25 atypical fractures of the ulna in the English and Japanese literature (11 and 7 reports, respectively) (Additional file 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

“…The papers included in the review are reported by category in Table 2. (15)(16)(17)25,26,(29)(30)(31)(32)(33) 205 Bone substitutes (41,42,45,46,48) 331 Growth factors (53,(55)(56)(57)(58) 615 Cell therapies (66,69,73) 69 Pharmacological therapy (97)** (98)(99)(100)(101)(102)(103)(104)(105)(107)(108)(109)(110)(111)(112)(113)(114) 110 ** Systematic review including case series and case reports.…”

“…Shimada et al [102] and Ito et al [103] reported the successful treatment of three cases of ulnar atypical fracture, with internal fixation, teriparatide and low-intensity pulsed ultrasound.…”