Uncommon Effect of Phenytoin on Fracture Union: Report of Two Cases

Prolonged phenytoin (PHD) therapy in epileptics predisposes patients to deleterious effects on bone health causing osteoporosis; however, despite its known effect on wound healing, collagen and fibroblast proliferation, and osteogenic differentiation, its impact on fracture healing remains poorly researched, we, report two cases of early exuberant callus formation in long bone fractures in patients undergoing long-term PHD therapy.

Two female patients with known seizure disorder on long-term PHD therapy experienced proximal humerus fractures after trivial trauma. Metabolic work-up revealed low serum calcium and Vitamin D3 levels with elevated ALP, serum osteocalcin, and iPTH. Despite planned surgery, both patients showed early exuberant callus formation post-trauma, leading to conservative management with successful outcomes.

Regular bone health monitoring is crucial for patients on long-term antiepileptic therapy, especially PHD users, to enhance treatment outcomes and address potential complications. Although the influence of PHD on fracture healing is uncertain, the cases presented hint at a potential beneficial correlation, indicating a need for more research in this domain.