Discussion
intermittent pneumatic compression, swelling, hypoxia, pain, fractures, posttraumatic oedema, lower extremity fractures
HYPOXIA, COMPLICATION
This study aimed to explore if administering VIT therapy as a form of intermittent pneumatic compression would improve soft-tissue conditioning and could consequently reduce the time until operability would be achieved. Following the discovery of venous return from the foot and the hand by means of both an active and passive venous pump, studies were carried out that tried to stimulate these mechanisms and improve and accelerate soft-tissue conditioning as well as thromboprophylaxis, especially during the posttraumatic immobilization period. The focus was primarily on ankle fractures, since the soft-tissue envelope is rather thin and perfusion critical here, leading to high complication rates due to posttraumatic oedema. However, there have only been limited studies on other lower extremity fractures and even less on the upper extremity.For tibial plateau and shaft fractures, only one published study with solely the abstract but not the full text in English could be found. This described a significantly faster reduction in swelling preoperatively in 68 cases of tibial and fibular fracturesNonetheless, in two of these studies, posttraumatic oedema was not examinedOnly two recent studies could be identifiedThus, this study is the first to examine the effect of VIT therapy in the perioperative management of different complex fractures of the lower and upper extremity compared to elevation using a physiologic stimulation of the venous pump in the foot and hand in a prospective, controlled, and randomized setting.This physiologic stimulation can be achieved by a fast pulsatile compression of the venous plexus as would result from weight bearing in case of the foot or clenching of the hand. This impulse induces shear stress, which in turn releases NO-reducing tissue hypoxia and improved blood flowIt could be shown that the delay to surgery could be reduced by 1–2.5 days. The difference was higher in the lower extremity subgroup for two reasons: swelling was more severe and so the venous pump was more effective and, in general, the delay to surgery in the upper extremity was rather short with a mean of 5–6 days. Decongestion was significantly improved by approximately 50% from which a mean reduction in swelling of around 4.5% per hour use of the VIT therapy can be calculated. Hence, the beneficial effect of intermittent pneumatic compressions on posttraumatic oedema that could only be anticipated from former studies in these fractures could now be further substantiated and proven.As described in a previous study, the improved microcirculation with fewer metabolites accumulating in the tissue is supposed to be the trigger of the lesser pain reported in the intervention group with three times as many patients reported being pain-free peroperatively and upon discharge