Elsabbagh Zaid, Ghanem Diane, Kollings Jack, Shafiq Babar, Mundy Lily, Sotsky Rachel, Hughes Alice, Shu Henry
Johns Hopkins University, Baltimore, United States.
Eur J Orthop Surg Traumatol. 2025 Jun 23;35(1):269. doi: 10.1007/s00590-025-04390-6.
Nitropaste, a topical nitroglycerin ointment, is recognized for its vasodilatory properties, which may enhance wound perfusion and reduce necrosis. Although widely used in plastic surgery, its application in orthopaedic surgery remains unexplored. This study evaluates the safety and feasibility of nitropaste during primary wound closure in high-risk lower extremity fractures.
A retrospective review was conducted at a Level I Trauma Center on patients who underwent ORIF for tibial plateau, pilon, and calcaneal fractures between January 2016 and March 2024. Patients who received a single 15 mg intraoperative dose of nitropaste at wound closure were identified. Outcomes included wound dehiscence, infection, and systemic adverse effects.
Among 18 patients (14 males, 4 females; mean age 51.2 ± 12.2 years), fracture distribution included 11 pilon, 6 tibial plateau, and 1 calcaneal fractures. No systemic adverse effects were reported. Wound healing was uneventful in 15 patients (83.3%), while 3 (16.7%) developed wound dehiscence and infection, necessitating reoperation. Importantly, the wound complication rate aligns with historical benchmarks for these fractures, suggesting nitropaste does not increase risk.
This feasibility study demonstrates a favorable safety profile and supports nitropaste's potential role in wound healing. Larger prospective studies with standardized dosing protocols are needed to define its clinical efficacy and optimize its use in high-risk orthopaedic wounds.
硝酸甘油糊剂是一种局部用硝酸甘油软膏，因其血管舒张特性而闻名，这种特性可能会增强伤口灌注并减少坏死。尽管它在整形外科中广泛使用，但其在骨科手术中的应用仍未得到探索。本研究评估了硝酸甘油糊剂在高危下肢骨折一期伤口闭合过程中的安全性和可行性。
在一家一级创伤中心对2016年1月至2024年3月期间接受胫骨平台、Pilon骨折和跟骨骨折切开复位内固定术（ORIF）的患者进行了回顾性研究。确定了在伤口闭合时接受单次术中剂量15毫克硝酸甘油糊剂的患者。结果包括伤口裂开、感染和全身不良反应。
18例患者（14例男性，4例女性；平均年龄51.2±12.2岁），骨折分布包括11例Pilon骨折、6例胫骨平台骨折和1例跟骨骨折。未报告全身不良反应。15例患者（83.3%）伤口愈合顺利，而3例（16.7%）出现伤口裂开和感染，需要再次手术。重要的是，伤口并发症发生率与这些骨折的历史基准一致，表明硝酸甘油糊剂不会增加风险。
这项可行性研究表明了良好的安全性，并支持硝酸甘油糊剂在伤口愈合中的潜在作用。需要进行更大规模的前瞻性研究，采用标准化给药方案，以确定其临床疗效并优化其在高危骨科伤口中的使用。
