Vol. 2, Issue 2, Part A (2025)

Background: Tibial shaft fractures are common long-bone injuries in young, economically active adults and are usually managed with intramedullary nailing or plaster immobilisation. Despite advances in fixation, delayed union, non-union and suboptimal functional recovery remain important challenges, especially in resource-constrained settings. Classical Ayurveda describes detailed principles of Asthi/Bhagna Chikitsā for fracture management, and osteogenic botanicals such as Cissus quadrangularis have shown promising experimental and clinical effects.
Objectives: To evaluate the effect of an Ayurvedic Orthopaedic Protocol based on Asthi Chikitsā as an adjunct to standard orthopaedic care on union, complications and functional outcomes in closed tibial shaft fractures.
Materials and Methods: In this prospective, randomised, parallel-group clinical study conducted at a tertiary care teaching hospital, 60 adults (18-60 years) with fresh, closed, unilateral tibial shaft fractures (AO/OTA 42A-B) were allocated to Group A (standard care plus Ayurvedic Orthopaedic Protocol) or Group B (standard care alone) (n = 30 each). Standard care consisted of intramedullary interlocking nailing or plaster immobilisation, as appropriate. The integrative protocol operationalised classical Asthi Chikitsā principles through structured bandaging, internal Cissus quadrangularis-based formulations, local therapies and graded physiotherapy. Primary outcomes were time to clinical and radiological union; secondary outcomes included complication rates and lower-limb functional scores at 12 and 24 weeks. Data were analysed using t tests, chi-square/Fisher’s exact-tests and Kaplan-Meier survival analysis with log-rank comparison.
Results: Baseline demographic and fracture characteristics were comparable between groups. Mean time to clinical union was significantly shorter in Group A than Group B (13.2 ± 2.1 vs 15.4 ± 2.4 weeks, P < 0.001), as was radiological union (14.5 ± 2.2 vs 16.8 ± 2.5 weeks, P < 0.001). At 24 weeks, radiological union was achieved in 29/30 (96.7%) patients in Group A and 22/30 (73.3%) in Group B (P = 0.03). Overall complications occurred in 1/30 (3.3%) versus 8/30 (26.7%) patients, respectively (P = 0.02), with delayed/non-unions confined largely to Group B. Functional scores improved in both groups but were higher in Group A at 12 weeks (54.6 ± 8.1 vs 48.2 ± 9.4, P = 0.01) and 24 weeks (69.1 ± 7.2 vs 61.3 ± 8.3, P = 0.002); 80.0% versus 53.3% of patients achieved good-excellent function at 24 weeks (P = 0.03). No serious adverse events attributable to the Ayurvedic regimen were observed.
Conclusion: The addition of a structured Ayurvedic Orthopaedic Protocol based on Asthi Chikitsā to standard orthopaedic management appears to enhance tibial fracture healing, reduce complications and improve functional recovery in closed tibial shaft fractures, without compromising safety. Larger multicentric trials with longer follow-up and mechanistic evaluation are warranted to confirm these findings and refine integrative protocols for long-bone trauma.