Local Erythropoietin Injection in Tibiofibular Fracture Healing

Abstract

BackgroundErythropoietin (EPO), in addition to its function as an erythropoiesis regulator has a regenerative activity on some nonhematopoietic tissues. Animal studies have suggested a role for erythropoietin in bone healing.ObjectivesThe present study aimed to evaluate the effects of local EPO injection in healing of tibiofibular fractures.Materials and MethodsIn a prospective double blind study, 60 patients with tibiofibular fracture were divided to equal EPO or placebo groups, randomly. Patients received local injection of either EPO or a placebo to the site of fracture two weeks after surgical fixation. Patients were followed by clinical and radiographic examination to determine the union rate. The period of fracture union and incidence of nonunion were compared between the two groups.ResultsThe demographic data and types of fractures were similar in the both groups. The mean duration of the fracture union was 2.1 weeks shorter in those treated with EPO (P = 0.01). Nonunion was observed in 6 patients of the control group and 2 receiving EPO (P = 0.02). No patient experienced any adverse effect from local EPO injections.ConclusionsEPO injection into the site of tibiofibular fractures may possibly accelerate healing.

Erythropoietin Promotes Bone Formation through EphrinB2/EphB4 Signaling

“…However, a recent prospective double-blind study was performed in which 60 patients received local injection of either EPO or a placebo into the site of a tibiofibular fracture 2 wk after surgical fixation (Bakhshi et al 2013). Patients who were treated with local EPO injections demonstrated 2-wk-faster union and lower nonunion rates compared to controls (Bakhshi 2013). While the sites of the skeletal defects are different, our data are consistent with a possible therapeutic for bone healing in humans.…”

“…Thus, it is possible that the use of EPO in a rodent wound-healing model may not reflect what is possible in humans. However, a recent prospective double-blind study was performed in which 60 patients received local injection of either EPO or a placebo into the site of a tibiofibular fracture 2 wk after surgical fixation (Bakhshi et al 2013). Patients who were treated with local EPO injections demonstrated 2-wk-faster union and lower nonunion rates compared to controls (Bakhshi 2013).…”

The effect of erythropoietin on bone

“…In agreement with the findings of this thesis, the majority of the published pre-clinical studies document an advantageous effect of EPO on early bone healing (Holstein et al 2007;Garcia et al 2011;. Taken together with the first data from a clinical trial, these findings indicate an improved healing process and (Bakhshi et al 2013). However, if this effect declines over time, as observed in vitro in Paper 2 and in vivo by Holstein et al, there may be no difference in the final outcome between EPO-treated and placebo-treated bone healing (Holstein et al 2007).…”

“…However, if this effect declines over time, as observed in vitro in Paper 2 and in vivo by Holstein et al, there may be no difference in the final outcome between EPO-treated and placebo-treated bone healing (Holstein et al 2007). In contrast, the fact that Bakhshi et al report that only two out of 30 EPO patients and six out of 30 control patients suffered from non-union may imply a beneficial outcome in the long term (Bakhshi et al 2013). …”

“…According to a recently published paper, topical EPO treatment reduced the time to clinical and radiographic union after tibiofibular fracture from 21.50 ± 3.18 to 19.35 ± 2.66 weeks (Bakhshi et al 2013). Notably, only two out of 30 patients in the EPO group suffered from non-union while this was the case in six out of 30 control patients.…”