Effects of the duration of transcutaneous CO2 application on the facilitatory effect in rat fracture repair

Background: Carbon dioxide therapy has been reported to be effective in treating certain cardiac diseases and skin problems. Although a previous study suggested that transcutaneous carbon dioxide application accelerated fracture repair in association with promotion of angiogenesis, blood flow, and endochondral ossification, the influence of the duration of carbon dioxide application on fracture repair is unknown. The aim of this study was to investigate the effect of the duration of transcutaneous carbon dioxide application on rat fracture repair.

Methods: A closed femoral shaft fracture was created in each rat. Animals were randomly divided into four groups: the control group; 1w-CO₂ group, postoperative carbon dioxide treatment for 1 week; 2w-CO₂ group, postoperative carbon dioxide treatment for 2 weeks; 3w-CO₂ group, postoperative carbon dioxide treatment for 3 weeks. Transcutaneous carbon dioxide application was performed five times a week in the carbon dioxide groups. Sham treatment, where the carbon dioxide was replaced with air, was performed for the control group. Radiographic, histological, and biomechanical assessments were performed at 3 weeks after fracture.

Results: The fracture union rate was significantly higher in the 3w-CO₂ group than in the control group (p < 0.05). Histological assessment revealed promotion of endochondral ossification in the 3w-CO₂ group than in the control group. In the biomechanical assessment, all evaluation items related to bone strength were significantly higher in the 3w-CO₂ group than in the control group (p < 0.05).

Conclusions: The present study, conducted using an animal model, demonstrated that continuous carbon dioxide application throughout the process of fracture repair was effective in enhancing fracture healing.