3. Can Combined Therapy With Teriparatide and Low-Intensity Pulsed Ultrasound (LIPUS) Accelerate Fracture Healing?

BACKGROUND: It is an advantage for orthopaedic surgeons to remove an Ilizarov external fixator as early as possible after surgery. Although both teriparatide and low-intensity pulsed ultrasound (LIPUS) have been found to accelerate fracture-healing processes, the effect of the combination of teriparatide and LIPUS in clinical bone fracture management remains unclear.

SUBJECTS: From among 721 patients with a lower limb fracture on admission to our department who underwent surgical treatment for a lower limb fracture with an Ilizarov external fixator, 38 patients over 60-year-old were investigated. Patients were either treated with an Ilizarov external fixator alone (IEF alone, n = 20) or an Ilizarov external fixator combined with teriparatide and LIPUS (IEF combination, n = 18). The patients' mean age was 64.1 years (range, 60-79 years) in the IEF alone group and 67.2 years (range, 60-83 years) in the IEF combination group. Teriparatide (20 μg subcutaneous injection daily or 56.5 μg subcutaneous injection once-weekly) and LIPUS (20 min/d) were started immediately after surgery for the IEF combination group in an attempt to accelerate healing of the lower limb fracture with the Ilizarov external fixator.

RESULTS: The mean time to union was 111.9 days (range, 94-175 days) for IEF alone and 72.1 days (range, 68-141 days) for the IEF combination; it was significantly shorter with the IEF combination. Bone density (relative to young adult mean, YAM) was 61.3% (range, 38%-82%) for IEF alone and 52.1% (range, 30%-79%) for the IEF combination. The mean AOFAS score was 86.2 (range, 72-100) for IEF alone and 91.2 (range, 82-100) for the IEF combination.

DISCUSSION: In elderly patients with lower limb fractures, combined therapy (teriparatide and LIPUS) showed a shorter mean duration of union than the Ilizarov external fixator alone. Combined therapy with teriparatide and LIPUS may become a useful option in the treatment of elderly patients with lower limb fractures.