Therapy of aseptic nonunions with parathyroid hormone

The absence of osseous consolidation of a fracture for 9 or more months with no potential to heal is defined as nonunion. Both for the patient and from a socioeconomic point of view, nonunions represent a major problem. Hypertrophic, vital nonunions are distinguished from atrophic avital ones. Risk...

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Bibliographic Details
Published in:European journal of orthopaedic surgery & traumatology 2019-01, Vol.29 (1), p.169-173
Main Authors: Kastirr, I., Reichardt, M., Andresen, R., Radmer, S., Schröder, G., Westphal, T., Mittlmeier, T., Schober, H. C.
Format: Article
Language:English
Subjects:
Age
Bones
Chronic illnesses
Diabetes
Fractures
Medicine
Medicine & Public Health
Metabolism
Original Article • FRACTURES - NON-UNION
Original • FRACTURES - NON-UNION
Osteoporosis
Patients
Surgery
Surgical Orthopedics
Teaching hospitals
Trauma
Traumatic Surgery
Vitamin D
Vitamin deficiency
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Summary:The absence of osseous consolidation of a fracture for 9 or more months with no potential to heal is defined as nonunion. Both for the patient and from a socioeconomic point of view, nonunions represent a major problem. Hypertrophic, vital nonunions are distinguished from atrophic avital ones. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces or residual instability, interposition of soft tissue within the fracture gap, as well as circulation disturbances and infections. The incidence of nonunions after fractures of the long bones lies between 2.6 and 16% depending on the surgical technique used. In human and animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. In this prospective study, 32 patients with nonunions were treated with teriparatide to investigate the effects of PTH on fracture healing. Definitive healing of the nonunions following PTH treatment could be observed in 95% of the cases.
ISSN:1633-8065
1432-1068
DOI:10.1007/s00590-018-2269-9