A clinical study on role of short course teriparatide injection in management of delayed union of fractures

Abstract

Background: Delayed union, is when healing has not advanced at required rate and has been prolonged for the location of fracture and involved bone in the expected time (usually 3-6 months) after initial trauma. Teriparatide is a synthetic analogue of the PTH Intermittent teriparatide subcutaneous injection can accelerate fracture healing by improving bone mass and skeletal architecture in non-union and delayed union and increase bone volume.Methods: A clinical study on role of short course teriparatide injection 20 mcg in management of delayed union was conducted on 40 patients . The patients were given daily 20 mcg injection teriparatide for 6 months and were evaluated for radiological and clinical signs of union at 6, 12, and 24 weeks of followup.Result: Humerus and tibia was the most common bone involved each constituting 32.5%. 70% patients did not have any underlying comorbidities. 14 patients were addicted to smoking. , serum calcium subsequently increased from weak 0 to week 24 (p=0.001). Moreover, the mean serum alkaline phosphatase also significantly increased from 74.85 (SD: 11.68) in week 0 to 81.50 (SD: 12.32) in week 24 (p<0.01).The VAS (pain) score was 3.95 (SD: 1.08) at 0 week which decreased to 1.90 (SD: 1.23) at 6 Weeks. 82.5% patients did not have any complications during the study, while 17.5% of them suffered from non-union of fracture.Conclusion: It was observed that teriparatide has a significant effect on increasing callus formation, increase in calcium levels, and a significant improvement in the clinical signs of union.