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Background: Delayed or non-union of fractures remains a substantial complication following surgical intervention. Teriparatide (rh-PTH), an osteoanabolic agent, has demonstrated potential in expediting fracture healing. This prospective observational study evaluated its efficacy in surgically corrected comminuted fractures. Methods: A cohort of 50 patients undergoing surgical correction for comminuted fractures was enrolled in the study. Teriparatide (20 mcg/day subcutaneous) was administered postoperatively for a duration of three months, commencing on postoperative day three or upon the detection of non-union. Clinical and radiographic assessments were conducted periodically for a period of up to twelve months. Results: Radiological union was achieved in 92% of cases, with the majority demonstrating union within a time frame of three to nine months. Functional recovery was substantial, with 52% of patients attaining full range of motion. Mild adverse effects, such as nausea (52%) and dizziness (28%), were reported. Conclusion: Teriparatide therapy exhibited favorable outcomes in terms of fracture healing and functional recovery, warranting its consideration as a complementary approach in managing comminuted fractures.
Fractures undergoing delayed or non-union pose significant morbidity and economic burden. While surgical methods remain the cornerstone of treatment, enhancing healing pharmacologically has gained interest. Teriparatide, a recombinant parathyroid hormone fragment, offers anabolic effects on bone and has been hypothesized to aid in fracture healing. This study aimed to evaluate its role in surgically corrected comminuted fractures.
Study Design
Prospective observational study conducted in the Orthopedics Department at Prathima Institute of Medical Sciences over two years (Oct 2019–Sept 2021).
Sample Size
50 patients with surgically corrected comminuted fractures.
Inclusion Criteria:
Exclusion Criteria:
Intervention:
Teriparatide (20 mcg/day) was administered subcutaneously for three months starting postoperatively or upon radiological detection of non-union.
Outcome Measures:
Parameters assessed included:
Table 1: Demographic and Baseline Characteristics
|
S.No |
Parameter |
Value |
|
1 |
Mean Age (years) |
40.4 ± 8.9 |
|
2 |
Gender Distribution |
Male: 82%, Female: 18% |
|
3 |
Mechanism of Injury |
RTA: 74%, Falls: 26% |
|
4 |
Most Affected Bones |
Femur (36%), Tibia (24%) |
Table 2: Radiological and Functional Outcomes
|
S.No |
Outcome |
Percentage (%) |
|
1 |
Radiological Union within 1 Year |
92% |
|
2 |
Complete Union (3–6 months) |
24% |
|
3 |
Complete Range of Motion |
52% |
|
4 |
Restricted Motion |
8% |
Table 3: Adverse Effects
|
S.No |
Side Effect |
Percentage (%) |
|
1 |
Nausea |
52% |
|
2 |
Dizziness |
28% |
|
3 |
Hypercalcemia |
18% |
The study demonstrated a 92% union rate with teriparatide as an adjunct therapy for surgically corrected comminuted fractures. Most patients achieved significant callus formation and union within 3–9 months. Functional outcomes were encouraging, with over half the patients regaining full joint motion. These findings align with existing case reports and clinical studies highlighting teriparatide's anabolic effects on bone regeneration. However, mild side effects like nausea and dizziness were common, which were manageable.
Other randomized controlled trials on teriparatide, such as Aspenberg et al. (2010) and Bhandari et al. (2016), yielded conflicting results due to sample size and fracture variability. Nevertheless, this
study strengthens evidence for teriparatide's utility in challenging fracture scenarios.
Teriparatide therapy significantly enhances fracture union and functional recovery in surgically corrected comminuted fractures. It presents a viable adjunct to surgical management, particularly in patients at risk of delayed union. Further large-scale, randomized trials are warranted to validate these findings
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