# Botulinum toxin in fracture management: a scoping review

## TL;DR

This review examines the use of botulinum toxin in treating fractures, finding mixed results but potential benefits in specific cases.

## Contribution

The paper provides a scoping review of botulinum toxin's role in fracture management, highlighting its potential and gaps in research.

## Key findings

- BoNT showed potential benefits in atypical and periprosthetic fractures and in patients with motor dysfunctions.
- Animal studies showed inconsistent effects on bone healing and callous formation.
- Clinical applications suggest BoNT can aid immobilization but require further research for validation.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s00590-025-04295-4.