Puvvada Chaitanya S, Soomro Faiza H, Osman Hafsa A, Haridi Merna, Gonzalez Natalie A, Dayo Sana M, Fatima Umaima, Sheikh Aaiyat, Penumetcha Sai Sri
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, IND.
Cureus. 2023 Apr 12;15(4):e37478. doi: 10.7759/cureus.37478. eCollection 2023 Apr.
Fracture nonunion remains a great challenge for orthopedic surgeons. Some bone fractures don't heal promptly, resulting in delayed unions and nonunions, and there is a need for an additional surgical procedure. Previous research has shown that teriparatide, a type of synthetic parathyroid hormone, can promote the formation of callus and lead to healing in individuals with delayed or non-healing bone fractures. Limited systematic reviews exist that examine the use of teriparatide in cases of delayed healing or non-healing bone fractures, which have their limitations. In this review, we overcome those limitations by including prospective studies, retrospective studies, case reports, and case series together. A systematic search of the literature was conducted in both PubMed and Google Scholar up to September of the year 2022. The studies included in our research included adult patients (over the age of 16) diagnosed with delayed union or nonunion of any bone in the body (flat bone, long bone, short bone, or irregular bone). The studies were limited to those written in English. The outcomes that were tracked and recorded include the healing of the fracture and any negative side effects or adverse events. The initial search yielded 504 abstracts and titles. After reviewing these, 32 articles were selected for further analysis, which included 19 case reports, five case series, two retrospective studies, and six prospective studies. Studies included daily (20 micrograms) or weekly (56.5 micrograms) subcutaneous administration of teriparatide. The duration of follow-up for these studies varied from three to 24 months. Based on the available research, it appears that administering teriparatide subcutaneously is a safe treatment option for delayed healing and non-healing bone fractures, with very few to no reported negative side effects. Using teriparatide for induction of callus formation and treating delayed and nonunions is highly safe and effective.
骨折不愈合仍然是骨科医生面临的巨大挑战。一些骨折无法迅速愈合，导致延迟愈合和不愈合，因此需要额外的外科手术。先前的研究表明，特立帕肽（一种合成甲状旁腺激素）可以促进骨痂形成，并使延迟愈合或不愈合的骨折患者实现愈合。现有的关于特立帕肽在延迟愈合或不愈合骨折病例中应用的系统评价有限，且存在局限性。在本综述中，我们通过纳入前瞻性研究、回顾性研究、病例报告和病例系列克服了这些局限性。截至2022年9月，我们在PubMed和谷歌学术上对文献进行了系统检索。我们研究纳入的患者为成年患者（16岁以上），诊断为身体任何部位（扁骨、长骨、短骨或不规则骨）的延迟愈合或不愈合骨折。研究限于英文撰写的文献。跟踪和记录的结果包括骨折愈合情况以及任何负面副作用或不良事件。初步检索产生了504篇摘要和标题。在对这些进行审查后，选择了32篇文章进行进一步分析，其中包括19篇病例报告、5篇病例系列、2篇回顾性研究和6篇前瞻性研究。研究包括每日（20微克）或每周（56.5微克）皮下注射特立帕肽。这些研究的随访时间从3个月到24个月不等。基于现有研究，皮下注射特立帕肽似乎是延迟愈合和不愈合骨折的安全治疗选择，很少有或没有报告的负面副作用。使用特立帕肽诱导骨痂形成以及治疗延迟愈合和不愈合骨折非常安全有效。
