gms | German Medical Science

Objectives/Interrogation: Teriparatide activates osteoblastic bone formation and effectively promotes bony union in distal radial fractures. Here we report two cases of distal radius malunion simultaneously treated using corrective osteotomy and beta-TCP with daily administration of teriparatide for osteoporosis.

Methods: The first case was a 64-year-old woman who underwent osteotomy for distal radius malunion. The surgery, which was performed 6 months after the trauma, comprised the following three steps: 1) an initial opening-wedge osteotomy, 2) implantation of an artificial bone graft (beta-TCP) in the bone defect, and 3) radius fixation using a volar locking plate. The patient was administered teriparatide injections (40 mg/day) for osteoporosis. Bony union was achieved within 3 months of surgery. The second case was a 57-year-old woman who also underwent osteotomy for distal radius malunion. The surgery, which was performed 5 weeks after the trauma, followed the same protocol as stated for the first case. This patient also received daily teriparatide injections for osteoporosis. Bonyunion was achieved within 7 weeks of surgery.

Discussion: Aspenberg, in his report, reported that teriparatide enhancesbony union following distal radius malunion. In particular, autologous bone grafting is considered the gold standard for the treatment of segmental bone defects in patients with distal radius malunion treated using corrective osteotomy. However, in osteoporotic patients, it is difficult to obtain a good quality graft even from the iliac bone. Yasuda reported that, as an alternative to autologous bone graft, bony union can also be provided using an artificial bone graft. Interestingly, Jacobson, in an animal model, reported that an artificial bone graft supplemented with teriparatide provides good bony union.

Teripratide reportedly promotes bony union; however, no study has yet demonstrated its role in artificial bone graft healing.

Conclusion: The addition of teriparatide to artificial bone grafts allows earlybone union. This study indicates that teripratide could help enhance bony union. Further, this method may serve as an alternative method of autogenous bone grafting.