Use of Anticoagulant Drugs in the Complex Treatment of Nonunion of Tibia Bones

Abstract

Relevance. Today there is no generally accepted scope of treatment for nonunion of the tibia. Treatment results are often unsatisfactory. The incomplete process of bone tissue repair is due to the presence of metabolic changes and vascular disorders. This suggests that the use of anti-clotting drugs in the complex treatment may contribute to better treatment results.
 Objective: to study the effectiveness of the use of antiplatelet drugs bemiparin and tranexamic acid in the complex repair of bone tissue.
 Materials and methods. 36 patients with tibia nonunion were treated. Complex therapy included surgical treatment (rehabilitation of inflammation and, if present, fistula sequestrectomy), fixation of fragments with ring fixators, antibacterial therapy according to generally accepted principles, conservative therapy of vascular disorders, correction of homeostasis. The comparison group consisted of 42 victims.
 To correct homeostasis before surgery, 750 mg of tranexamic acid solution was administered intravenously to reduce the risk of bleeding. In 6 hours after surgery, in order to prevent thrombosis, a prophylactic dose of bemiparin (Cibor) 25000 units was administered. The administration was carried out for 7 days. The state of blood homeostasis was assessed on 1, 3 and 7 days after surgery by the following indicators: platelet count, level of soluble fibrin-monomer complexes, prothrombin time, activated partial thromboplastin time, international normalized ratio.
 The condition of the tibia was assessed by the following indicators: the presence of fluid in the subfascial space, the condition of the fascia, muscles and blood vessels (assessed by ultrasound); asymmetry of the temperature of the feet and legs of healthy and injured limbs (using an infrared non-contact thermometer); the value of intratissue pressure on the tibia (using the Striker apparatus at certain points).
 The results of tibia treatment after fractures were evaluated using the anatomical and functional scale Modified Functional Evaluation System by Karlstrom-Olerud.
 Results. There was no significant blood loss during surgery and thromboembolic complications. Clinical data and indicators of intrafascial pressure in the outer and superficial posterior fascial compartments indicated the development of local hypertensive ischemic syndrome. The dynamics of foot thermoasymmetry, ultrasound data are characteristic of subcompensated functional disorders with the theoretical possibility of their recovery. The obtained data indicate a violation of blood flow with a high risk of possible thrombosis, which is an objective basis for the appointment of low molecular weight heparin. The dynamics of most of the examined indicators of blood homeostasis during the prescribed therapy did not differ statistically, but there was a tendency to shift the indicators to the recommended safe zone.
 Conclusions. Clinical data indicate the high efficacy of Cibor in the complex therapy of septic nonunions.