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The Journal of Bone and Joint Surgery (American) 85:1446-1453 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Effect of Intermittent Pneumatic Soft-Tissue Compression on Fracture-Healing in an Animal Model

Sang-Hyun Park, PhD and Mauricio Silva, MD

Investigation performed at The J. Vernon Luck Sr. M.D. Orthopaedic Research Center at Orthopaedic Hospital/University of California at Los Angeles, Los Angeles, California

Sang-Hyun Park, PhD
Mauricio Silva, MD
The J. Vernon Luck Sr. M.D. Orthopaedic Research Center at Orthopaedic Hospital/University of California at Los Angeles, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for S.-H. Park: spark{at}laoh.ucla.edu

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Los Angeles Orthopaedic Hospital Foundation. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. For financial support, The Max Factor Family Foundation donated the peripheral computerized tomography device.

Background: The fracture-healing process is closely related to blood supply. Intermittent pneumatic compression of the surrounding soft tissue may alter blood flow and, therefore, modify the healing process. The object of the present study was to evaluate the effect of intermittent pneumatic compression on fracture-healing in an animal model.

Methods: Unilateral, transverse, mid-tibial osteotomies with a 3-mm gap were performed in thirty rabbits. The osteotomy site was stabilized with a double-bar external fixator. The femoral vein was ligated to induce venous stasis. Beginning on the fourth postoperative day, fifteen rabbits were treated with intermittent pneumatic compression with use of four rubber balloons, two around the distal part of the calf and two around the midpart of the calf, for one hour daily for four weeks (the study group) and fifteen rabbits were not treated with intermittent pneumatic compression (the control group). Peripheral computerized tomographic examination was performed biweekly to measure callus area and mineral content at the fracture gap. At eight weeks, the rabbits were killed, and the biomechanical properties of the healing fractures were evaluated with a torsional test.

Results: An increase in callus area and mineral content at the osteotomy gap was observed in the study group, compared with the values in the control group, starting four weeks after the index procedure. At six weeks, the rabbits treated with intermittent pneumatic compression exhibited, on the average, a 32.2% larger callus area (p = 0.035) and a 49.7% higher mineral content (p = 0.01) at the osteotomy site compared with the values in the control group. The torsional stiffness, maximum torque, angular displacement at maximum torque, and energy required to failure of specimens in the study group were an average of 27.0% (p = 0.05), 61.5% (p = 0.0001), 35.4% (p = 0.0003), and 110.8% (p = 0.0001) higher, respectively, than those in the control group at eight weeks.

Conclusions: Intermittent pneumatic compression enhanced callus mineralization and development and it improved the biomechanical properties of a healing osteotomy site in the rabbit tibia.

Clinical Relevance: The use of intermittent pneumatic compression in patients with an acute fracture, especially in the lower limb, may improve bone-healing.


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