Department of Orthopedic Surgery, National Taiwan University Hospital No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei 100225, Taiwan.
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 100225, Taiwan.
Medicina (Kaunas). 2022 Jul 23;58(8):983. doi: 10.3390/medicina58080983.
The nonunion rate of surgically treated basicervical peritrochanteric fractures has been reported to be as high as 9%. Due to the high 1-year mortality rate following revision surgery, finding an effective nonsurgical treatment option is of interest. Over the last decade, numerous reports have been published that have suggested teriparatide as an effective treatment for certain types of fracture nonunion. However, the literature focused on teriparatide treatment for proximal femoral fracture nonunion is scanty. A 70-year-old man suffering from a left hip basicervical peritrochanteric fracture received cephalomedullary nail fixation. Nine months after the surgery, the patient still complained of left hip pain referring to the medial thigh with an antalgic limping gait. No sign of healing was noted for more than a consecutive 3 months of follow-up. Fracture nonunion was diagnosed and further confirmed by the computed tomography (CT). The patient preferred nonsurgical treatment after thorough discussion. He then received 4 months of subcutaneous teriparatide injections, 20 mcg daily. After less than 4 months of teriparatide treatment, a follow-up CT confirmed fracture union and the patient's pain subsided. The patient also tolerated independent ambulation afterward. Teriparatide has been reported to be an effective treatment for certain types of fracture nonunion. Our case goes a step further to expand its possible application for basicervical peritrochanteric fracture nonunion. However, further larger scale studies are needed to confirm its efficacy.
手术治疗的股骨颈基底粗隆间骨折不愈合率高达 9%。由于翻修手术后 1 年的死亡率较高，因此寻找有效的非手术治疗选择很有意义。在过去的十年中，已经有许多报告表明特立帕肽是治疗某些类型骨折不愈合的有效方法。然而，关于特立帕肽治疗股骨近端骨折不愈合的文献却很少。一名 70 岁男性患有左侧髋骨基底粗隆间骨折，接受了股骨近端髓内钉固定术。手术后 9 个月，患者仍诉左侧髋部疼痛，放射至大腿内侧，伴有跛行步态。连续 3 个月以上的随访均未见愈合迹象。经 CT 进一步确诊为骨折不愈合。经充分讨论后，患者选择非手术治疗。随后，他接受了 4 个月的特立帕肽皮下注射，每天 20 mcg。在接受特立帕肽治疗不到 4 个月后，随访 CT 证实骨折愈合，患者的疼痛缓解。患者此后也能独立行走。特立帕肽已被报道为治疗某些类型骨折不愈合的有效方法。我们的病例更进一步扩大了其在股骨颈基底粗隆间骨折不愈合中的可能应用。然而，需要进一步的大规模研究来证实其疗效。
