Osseous Consolidation of an Aseptic Delayed Union of a Lower Leg Fracture after Parathyroid Hormone Therapy – A Case Report
Published: July 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/.8203
Ilko Kastirr, Sebastian Radmer, Reimer Andresen, Hans-Christof Schober
1. Medical Assistant, Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Germany.
2. Head of the Centre for Orthopaedics, Berlin, Germany.
3. Head of the Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Germany.
4. Head, Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Germany.
Correspondence
Dr. Ilko Kastirr,
Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide
Esmarchstr. 50, 25746 Heide, Germany.
E-mail: ikastirr@wkk-hei.de
The absence of osseous consolidation of a fracture within the normal time period is defined as delayed union or non-union. Both for the patient and from a socio-economic point of view, impaired fracture healing represents a major problem. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces, interposition of soft tissue in the fracture gap, as well as circulation disturbances, metabolic disease, smoking and infections. In 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. Few cases with the empiric off-label use of PTH that showed a tendency to support delayed or non-union fractures have been published. We report about a patient with a fracture of the lower leg and no osseous consolidation after 7 months. Four Months after therapy with 20 µg teriparatide per day for 8 weeks the fracture was consolidated and the patient had regained full and pain free weight bearing capacity of the leg with no reported side effects.
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