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. 2025 Jun 23;35(1):269.
doi: 10.1007/s00590-025-04390-6.

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

Zaid Elsabbagh  1 , Diane Ghanem  2 , Jack Kollings  2 , Babar Shafiq  2 , Lily Mundy  2 , Rachel Sotsky  2 , Alice Hughes  2 , Henry Shu  3
Affiliations

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

Zaid Elsabbagh et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Bicondylar Tibial plateau fractures; Calcaneal fractures; Nitropaste; Pilon fractures; Wound healing.

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Conflict of interest statement

Declarations. Conflict of interests: Several authors have disclosed funding sources or professional affiliations not directly relevant to this study. These include postdoctoral funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (5T32AR067708-10); consulting roles with Arthrex, Inc., BoneFoam, Smith & Nephew, Synthes, and Zimmer; research support from DePuy (a Johnson & JohnsonCompany) and Synthes; stock or stock options in Restor3D; intellectual property royalties from Elsevier Publishing; and editorial or board memberships with Frontiers in Surgery, Orthopaedic Surgery, and the Orthopaedic Trauma Association. No monetary funding was received directly for the completion of thismanuscript.

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