Repetitive brief ischemia accelerates tibial shaft fracture healing: a 5-years prospective preliminary clinical trial (PCT)

Abstract

Background This study was to evaluate the effects of repetitive brief ischemia (RBI) on bone healing in patients with tibial shaft fractures. Methods In 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). Results A 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. Conclusions RBI is a new method to accelerate bone healing in tibia shaft fracture patients and is a simple and noninvasive method. Trial registration Chinese clinical trial registry, ChiCTR-INR-17014208. Registered 28 December 2017—Retrospectively registered.

Proteomic analysis of exosomal proteins associated with bone healing speed in a rat tibial fracture model

“…Four weeks after the fracture, the formation of the fracture callus gradually progressed, and the levels of BMP-2, osteocalcin, and ALP gradually decreased. These findings are consistent with previous studies on the progression of bone healing (Wang et al, 2021).…”

Methods to accelerate fracture healing – a narrative review from a clinical perspective

“…The injection of the same factors in patients without TBI may lead to the same effects, which should be tested in clinical intervention studies. In fracture patients, brief periods of ischaemia generated by pneumatic cuff compression were also shown to accelerate bone fracture healing, likely through the release of BMP-2 and other growth factors ( 90 ). This promising method requires further well-designed clinical studies.…”

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“…Fractures are a frequently encountered condition in clinical settings, with tibia fractures in adults being particularly prevalent [ 1 ]. The process of fracture repair is intricate and protracted, and delayed healing imposing substantial burdens on patients [ 2 ].…”