Effect of high-dose low molecular weight heparin on the healing of femoral shaft fractures

Shi Tengbo; Tang Yanfeng; Zhang Mengyu; Wang Xingfei; Li Chenyang; Shi Jinyu; Guo Chaowei; Li Yanzhou; He Zike; Wang Shangzeng

doi:10.12307/2026.718

Abstract：BACKGROUND:Patients with femoral shaft fractures often have a risk of deep vein thrombosis,and low molecular weight heparin is a commonly used medication for preventing deep vein thrombosis.However,the effect of low molecular weight heparin on fracture healing remains controversial,with some studies suggesting that it may inhibit osteoblast differentiation and delay fracture healing. OBJECTIVE:To investigate the effect of high-dose low molecular weight heparin on the healing of femoral shaft fractures. METHODS:The data of 100 patients with femoral shaft fractures from January 2023 to December 2023 were analyzed,including 51 males and 49 females,aged(56.26±15.46)years.According to the presence of deep vein thrombosis detected by bilateral lower limb ultrasound screening within 12 hours after admission,they were divided into a non-thrombosis group and a thrombosis group,with 50 cases in each group.The non-thrombotic group received subcutaneous injection of low molecular weight heparin into the abdomen to prevent thrombosis,at a dose of 100 U/kg,once a day,for 2 consecutive weeks.The thrombosis group was treated with subcutaneous injection of low molecular weight heparin into the abdomen for anticoagulation therapy of thrombosis,at a dose of 100 U/kg,every 12 hours,for 2 consecutive weeks.The swelling score of the affected limb,radiographic union score for tibia,fracture healing time,and Hospital for Special Surgery limb function score in both groups were recorded. RESULTS AND CONCLUSION:A total of 93 patients completed follow-up,including 48 cases in the thrombosis group and 45 cases in the non-thrombosis group.There was no significant difference in preoperative general information between the two groups of patients(P>0.05).The limb swelling scores of the thrombosis group were significantly higher than those of the non-thrombosis group at 3 days and 1 week after surgery(P<0.05).The fracture healing time of the thrombosis group was significantly longer than that of the non-thrombosis group(P<0.05).The radiographic union score for tibia and Hospital for Special Surgery limb function score in the thrombosis group were significantly lower than those in the non-thrombosis group at 3 months after surgery(P<0.05).There was no significant difference in radiographic union score for tibia and Hospital for Special Surgery limb function score between the two groups of patients at 6 and 9 months after surgery(P>0.05).These results indicate that early application of high-dose low molecular weight heparin can delay fracture healing and increase potential bleeding risk,but has no significant effect on the final healing rate of femoral shaft fractures.