ABSTRACT
STUDY DESIGN: An open-label, non-randomized prospective study. PURPOSE: Teriparatide (TPTD) is known to be an antiosteoporotic agent that may accelerate the healing of fractures. This study was designed to investigate the effect of once-weekly TPTD administration on vertebral stability and bony union after acute osteoporotic vertebral fracture (OVF). OVERVIEW OF LITERATURE: Once-weekly TPTD administration can lead to early vertebral stability and promote bony union of fractured vertebrae in patients with severe osteoporosis. METHODS: Forty-eight subjects with acute OVF were assigned to receive activated vitamin D3 and calcium supplementation or onceweekly subcutaneous injection of TPTD (56.5 μg) in combination with activated vitamin D3 and calcium supplementation for 12 weeks. Vertebral stability was assessed using lateral plain radiography. Vertebral height at the anterior location (VHa) and the difference in VHa {ΔVHa=VHa (supine position)−VHa (weight-bearing position)} were measured at baseline and 12 weeks after starting treatment. Bony union was defined as the absence of a vertebral cleft or abnormal motion (ΔVHa >2 mm). RESULTS: Although not significant, ΔVHa, indicating vertebral stability, tended to be lower in the TPTD group at 12 weeks (p=0.17). As for subjects with severe osteoporosis, ΔVHa at 12 weeks was significantly lower in the TPTD group than in the control group (mean ΔVHa: control group, 3.1 mm (n=15); TPTD group, 1.4 mm (n=16); p=0.02). The rate of bony union was significantly higher in the TPTD group than in the control group (control group, 40%; TPTD group, 81%; p=0.03). CONCLUSIONS: Once-weekly TPTD administration may facilitate early bony union after acute OVF accompanied by severe osteoporosis.
ABSTRACT
BACKGROUND: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. METHODS: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, 90° flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. RESULTS: Ulno-humeral joint moved to the varus on the coronal plane during flexion, 25.45° in the non-united cubitus valgus group and −2.03° in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane −26.75° in the non-united cubitus valgus group and −3.09° in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. CONCLUSIONS: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.