Scope and Limits of Teriparatide Use in Delayed and Nonunions: A Case Series

Nonunion is known to occur in up 10% of all bone fractures. Until recently, the treatment options considered cases delayed union and nonunion focused on revision surgery improvement local healing. Lately, teriparatide has been introduced as an osteoanabolic factor that induces fracture healing with or nonunions. We report a series five nonunions treated teriparatide: unions atypical femoral fracture, multifragmentary clavicle periprosthetic humeral fracture; tibial fibular infected fracture. Based this series, indications limits application impaired are discussed. Due “off-label” character application, informed consent, cost coverage from healthcare insurance must be obtained prior treatment. In our experience according limited existing literature, safe feasible reasonable need resources. While adequate biomechanical stability remains cornerstone healing, well nonunions, could help avoid repetitive surgeries, especially atrophic patients undergoing bisphosphonate therapy. There urgent for widely accepted definitions, standardized protocols, further clinical trials field