title: Combined effect of teriparatide and low-intensity pulsed ultrasound for nonunion: a case report.
abstract: BACKGROUND
  Low-intensity pulsed ultrasound is a pain-free therapy performed daily at home by the patient and has been shown to promote fracture healing. Teriparatide is a parathyroid hormone preparation that activates osteoblastic bone formation and is also reported to be effective in promoting bony union.
  
  
  METHODS
  We report the case of a 56-year-old Japanese male with a femoral shaft fracture who underwent intramedullary osteosynthesis nailing initially. He had no radiologic or clinical sign of healing 3 months later and low-intensity pulsed ultrasound was initiated at that time. He was reassessed in another 3 months, with evidence of mild bone consolidation but the fracture gap persisted. Subsequent treatment with human parathyroid hormone was initiated in combination with low-intensity pulsed ultrasound. Full fracture healing was present 6 months after beginning the combination low-intensity pulsed ultrasound and teriparatide. It is hypothesized that the potential additive effects of low-intensity pulsed ultrasound and teriparatide therapy ultimately triggered sufficient bone formation to support osseous union.
  
  
  CONCLUSIONS
  The case reported herein is a femoral shaft atrophic nonunion in which traditional interventions failed. Successful fracture healing was finally achieved with low-intensity pulsed ultrasound and teriparatide therapy. This is the first reported case of diaphyseal nonunion with deterioration of bone quality in long bones resolved with teriparatide and low-intensity pulsed ultrasound.
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. kk-nozaka@mue.biglobe.ne.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Nozaka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.forename: Shin
authors.initials: S
authors.lastname: Yamada
authors.forename: Michio
authors.initials: M
authors.lastname: Hongo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kasukawa
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Saito
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kijima
mesh_terms: D003131:Combined Modality Therapy; D050723:Fractures, Bone / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019379:Teriparatide / Q000627:therapeutic use*; D014464:Ultrasonic Therapy
chemical_list: D019379:Teriparatide