J Korean Orthop Assoc.  2016 Jun;51(3):231-237. 10.4055/jkoa.2016.51.3.231.

Effects of Teriparatide Administration on Fracture Healing after Intramedullary Nailing in Atypical Femoral Fractures

• Park CH
• Shon OJ
• Moon JJ
• Shim BJ
• Heo JH

• KMID: 2308584
• DOI: http://doi.org/10.4055/jkoa.2016.51.3.231

Abstract

PURPOSE
The purpose of this study is to evaluate the effects of teriparatide administration on fracture healing after intramedullary nailing in atypical femoral fractures.
MATERIALS AND METHODS
We retrospectively reviewed 26 patients (26 cases) with atypical femoral fracture who were treated using intramedullary nailing between January 2009 and December 2013. Teriparatide was not administered to 15 patients (non-injection group) and was administered to 11 patients after surgery (injection group). Clinical results were assessed using the Nakajima score and the visual analogue scale (VAS). Radiographic results were compared for the time of callus formation, callus bridge formation, and bone union between the groups.
RESULTS
Time to recover walking ability and to decrease pain in the surgery region (VAS≤2) were significantly shorter in the injection group than in the non-injection group. The time of callus formation, callus bridge formation, and bone union was significantly shorter in the injection group than in the non-injection group. There were 5 cases of delayed bone union (33.3%) and 1 case of none union (6.7%) in the non-injection group and all cases obtained bone union in injection group.
CONCLUSION
The injection group showed better clinical and radiographic results than the non-injection group after intramedullary nailing in atypical femoral fracture. Therefore, we think that teriparatide administration after intramedullary nailing could be a useful treatment option to promote bone union.

Keyword

atypical femoral fracture; intramedullary nailing; parathyroid hormone

MeSH Terms

Bony Callus
Femoral Fractures*
Fracture Fixation, Intramedullary*
Fracture Healing*
Humans
Parathyroid Hormone
Retrospective Studies
Teriparatide*
Walking
Parathyroid Hormone
Teriparatide

Figure

• 

  Figure 1 A 76-year-old female using bisphosphonate for six years was diagnosed as an atypical femoral fracture (AFF). (A) Anteroposterior radiograph of the left femur shows AFF. (B) Radiographs, obtained immediately operatively, show the fixation using an intramedullary nail. After surgery, the patient started administration of teriparatide 20 µg a day. (C) Radiographs obtained at 6 weeks after surgey show callus formation at the fracture site. (D) Radiographs obtained at 10 weeks after surgery show callus bridge formation at the fracture site. (E) Radiographs obtained at 24 weeks after surgery show complete bony union at the fracture site.

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