Abstract
BackgroundThis study was to evaluate the effects of repetitive brief ischemia (RBI) on bone healing in patients with tibial shaft fractures.MethodsIn this prospective clinical trial, patients with tibia shaft fractures were enrolled between January 2016 and January 2021. The intermittent pneumatic compression (IPC) device was used to make RBI on the affected limb after surgical operation 24 h. The inflation pressure was the systolic pressure of patients + 50 mmHg. Patients were received 30 s inflation/30 s deflation 30 times twice a day for 4 weeks. The primary outcome was bone healing time and the secondary outcomes were the rates of delayed union and nonunion, the rates of venous thrombosis of lower limbs, Johner-Wruhs scores, Lysholm knee score, VAS scores, postoperative complications, serum BMP-2, osteocalcin (OC) and bone specific alkaline phosphatase (BS-ALP).ResultsA total of 32 patients were enrolled finally and all were completed with a 12 months follow-up. All the fractures were healed and the bone healing time was 3(1) months in RBI group. However, the bone healing time of control group was 4(1) and there was statistical difference between the two groups (p < 0.01). No patient with fracture delayed union, nonunion and venous thrombosis of lower limbs in RBI group. 2 patients were delayed union in the control group. In RBI group, the Lysholm knee score was 83(6) at 6 months and 100(8) at 12 months. In the control group, the score was 78(4) and 90.5(17), there was statistical difference between the two groups (p < 0.01, p = 0.014, respectively). VAS scores were postoperative 2 weeks 6(1) in RBI group and 7(0.5) in the control group, there was statistical difference between the two groups (p = 0.016). There were 2 patients with intramuscular venous thrombosis of lower extremity in control group. Besides, RBI treatment increased the serum BMP-2, OC and BS-ALP at postoperative 2 weeks and 1 month.ConclusionsRBI is a new method to accelerate bone healing in tibia shaft fracture patients and is a simple and noninvasive method.Trial registrationChinese clinical trial registry, ChiCTR-INR-17014208. Registered 28 December 2017—Retrospectively registered.
Highlights
Fracture is the most common trauma in orthopaedics and causes more than 150,000 patients hospitalisations in Australia each year [1]
In 2016, we explored the effects of affected limb repetitive brief ischemia (RBI) on bone healing in a rat tibia fracture model and found that RBI treatment can promote fracture healing and stimulate the secretion of Insulin-like growth factor-2 (IGF-2) [4]
Primary outcome was the bone healing time, in addition, the secondary outcomes were the rates of delayed union and nonunion, the rates of venous thrombosis of lower limbs, Johner-Wruhs scores, Lysholm knee score, visual analogue scale (VAS) scores, postoperative complications, such as wound infection, fracture of internal fixation, loss of fracture reduction and vascular or nerve injury, and serum cytokines, such as bone morphogenetic protein-2 (BMP-2), osteocalcin (OC) and bone specific alkaline phosphatase (BS-Alkaline phosphatase (ALP))
Summary
Fracture is the most common trauma in orthopaedics and causes more than 150,000 patients hospitalisations in Australia each year [1]. Wang et al BMC Musculoskelet Disord (2021) 22:631 promote bone healing and some of them have been used in clinic, the rate of delayed union or nonunion has not decreased significantly [2, 3]. The rate of bone nonunion is about 5–10% and tibia fracture nonunion or delayed union is 25% [3], besides, the direct costs for healthcare and loss of productivity in the first 6 months post-injury are about $23,000 for each limb fracture. Most of patients will undergo a revision surgery, which will cause a secondary injury of the patients. This study was to evaluate the effects of repetitive brief ischemia (RBI) on bone healing in patients with tibial shaft fractures
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