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. 2025 Jun 4;35(1):233.
doi: 10.1007/s00590-025-04295-4.

Botulinum toxin in fracture management: a scoping review

Emmanuel Spanoudakis  1 , Themistoklis Vampertzis  2 , Farokh Wadia  3 , Darius Rares Rad  3 , Christina Barmpagianni  4 , Ioannis A Zervos  5 , Eleftherios Tsiridis  6   5 , Nikiforos Galanis  5
Affiliations

Botulinum toxin in fracture management: a scoping review

Emmanuel Spanoudakis et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: Using botulinum toxin (BoNT) as an adjunct in fracture management is a novel approach with the potential to improve clinical outcomes, particularly in atypical fractures and patients with concurrent neuromuscular disorders. This scoping review explores the literature on BoNT's effectiveness in facilitating fracture healing and immobilisation across various fracture types.

Methods: The PubMed, Embase, and Cochrane databases were searched with defined operators. Two investigators conducted independent searches, which were combined. Animal studies, case reports, case series, cohort reviews and randomised control trials were included.

Results: Fifty studies were identified for screening, from which 15 studies were included in the review. The findings highlight mixed outcomes in BoNT's role in enhancing bone healing and reducing muscle-induced displacement. While BoNT injections demonstrated potential benefits in specific cases, such as atypical fractures, periprosthetic fractures and fractures in patients with motor dysfunctions, results from animal studies were inconsistent, showing varied effects on callous formation and bone mineral density.

Conclusion: Clinical applications of BoNT in fracture management indicate its utility as an immobilisation agent to promote fracture healing and reduce complications. However, this review highlights that further research is necessary to bridge the gap between experimental and clinical studies and to clarify BoNT's effectiveness in different use cases.

Keywords: Botulinum toxin; Fracture healing; Fracture immobilisation; Maxillofacial fractures; Muscle paralysis; Orthopaedic trauma.

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Conflict of interest statement

Declaration. Conflict of interests: The authors declare no competing interests. Human ethics and consent to participate: Not Applicable.

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