TERIPARATIDE-ASSISTED UNION IN DELAYED UNION AND INFECTED DELAYED UNION OF LONG-BONE SHAFT FRACTURES: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Delayed union of long-bone shaft fractures remains a persistent problem in trauma practice, especially in tibia and femur injuries with soft-tissue compromise. Teriparatide is a biologically plausible adjunct for fracture healing, but real-world evidence in delayed union cohorts remains heterogeneous. Methods: We conducted a retrospective observational study of 50 adults with delayed union or infected delayed union of long-bone shaft fractures managed with stable fixation and teriparatide. Only diaphyseal fractures were included; intra-articular and metaphyseal fractures were excluded. Fractures were classified using Gustilo-Anderson (open fractures) and AO classification. Results: Mean time from fracture to teriparatide initiation was 3.6+/-0.4 months. Mean radiological union time from teriparatide start was 3.5+/-0.6 months, and complete union from index surgery was 15.1+/-1.8 months overall. Six cases required revision surgery (femur n=3, tibia n=2, radius n=1); these showed prolonged union from index surgery (18.7+/-1.5 months) but achieved union within 5.0+/-0.6 months after revision. Conclusion: Teriparatide may support fracture healing in delayed union when mechanical stability is maintained; open injuries and infected delayed union remain slower-healing subgroups.