Topical nitroglycerin for high-risk orthopaedic trauma wounds: a feasibility study on safety and wound healing...

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.