Abstract
We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2) in 44 patients who underwent dynamic hip screw (DHS) fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P < 0.001 and P < 0.001, resp.) but not at 12 months or the last follow-up. The pain scores were also significantly better in the teriparatide-treated group at 3 and 6 months (P = 0.040 and P = 0.041, resp.) but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.
Highlights
Pertrochanteric fracture is a relatively common and serious clinical issue in geriatric trauma
This study aimed to assess whether adding teriparatide postoperatively would enhance the success rate of dynamic hip screw (DHS) in unstable pertrochanteric fractures using a retrospective analysis of 2 groups of elderly patients with osteoporosis: one that received teriparatide and another that received only calcium replacement therapy
Fifty patients were in group A and 31 patients were in group B
Summary
Pertrochanteric fracture is a relatively common and serious clinical issue in geriatric trauma. Osteoporotic bone and fracture comminution are critical for bone anchorage of the implants and subsequent motion between fragments. The dynamic hip screw (DHS) has been used widely in osteoporotic pertrochanteric fractures. Lag screw cutting out and excessive sliding with varus and shortening deformity limit its use in such osteoporotic fractures. To avoid such complications, cement augmentation and a trochanter stabilization plate (TSP) have been used. According to the Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification [10], the fractures are classified as either stable (31-A1) or unstable (31-A2 and 31-A3).
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