K M Peters1, T Tuncel2. 1. Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland. kpeters@dbkg.de. 2. Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland.
Abstract
BACKGROUND: The treatment of fracture nonunion (pseudarthrosis) is often lengthy and debilitating for the patient. There are operative and conservative therapies available. RESEARCH QUESTION: Does the systemic use of osteoanabolic acting substances (osteoanabolics) lead to an acceleration of the delayed fracture healing and/or strengthening of the fracture? Which types of pseudarthrosis are suitable for this treatment option? MATERIALS AND METHODS: A literature review was carried out focusing on the systemic anabolic therapy options for the treatment of delayed healing of fractures or pseudarthrosis. Additionally, our own case studies are presented. RESULTS: Teriparatide and strontium ranelate have a positive effect on the healing of fractures in animal studies and in humans. There are also case studies on the use of both substances in delayed fracture healing or pseudarthrosis. The scientific knowledge regarding teriparatide is significantly more comprehensive. However, prospective randomized trials are lacking so far. CONCLUSION: The systemic use of anabolics can be a therapeutic option, especially for biological reactive pseudarthrosis. However, these are off-label treatments and contraindications should be especially well heeded. Because of the numerous positive results, from the point of view of teriparatide treatment, a multicentric, prospective randomized study on the treatment of aseptic pseudarthrosis should be initiated.
BACKGROUND: The treatment of fracture nonunion (pseudarthrosis) is often lengthy and debilitating for the patient. There are operative and conservative therapies available. RESEARCH QUESTION: Does the systemic use of osteoanabolic acting substances (osteoanabolics) lead to an acceleration of the delayed fracture healing and/or strengthening of the fracture? Which types of pseudarthrosis are suitable for this treatment option? MATERIALS AND METHODS: A literature review was carried out focusing on the systemic anabolic therapy options for the treatment of delayed healing of fractures or pseudarthrosis. Additionally, our own case studies are presented. RESULTS:Teriparatide and strontium ranelate have a positive effect on the healing of fractures in animal studies and in humans. There are also case studies on the use of both substances in delayed fracture healing or pseudarthrosis. The scientific knowledge regarding teriparatide is significantly more comprehensive. However, prospective randomized trials are lacking so far. CONCLUSION: The systemic use of anabolics can be a therapeutic option, especially for biological reactive pseudarthrosis. However, these are off-label treatments and contraindications should be especially well heeded. Because of the numerous positive results, from the point of view of teriparatide treatment, a multicentric, prospective randomized study on the treatment of aseptic pseudarthrosis should be initiated.
Authors: Per Aspenberg; Harry K Genant; Torsten Johansson; Antonio J Nino; Kyoungah See; Kelly Krohn; Pedro A García-Hernández; Christopher P Recknor; Thomas A Einhorn; Gail P Dalsky; Bruce H Mitlak; Anke Fierlinger; Mark C Lakshmanan Journal: J Bone Miner Res Date: 2010-02 Impact factor: 6.741
Authors: Barbara M Obermayer-Pietsch; Fernando Marin; Eugene V McCloskey; Peyman Hadji; Jordi Farrerons; Steven Boonen; Maurice Audran; Clare Barker; Athanasios D Anastasilakis; William D Fraser; Thomas Nickelsen Journal: J Bone Miner Res Date: 2008-10 Impact factor: 6.741