Therapeutic Effects of Topical Traditional Chinese Medicine on Upper Extremity Fractures

Wan-Yi Lin,1,* Chuan Angel Lu,1,2,* Chia-Wei Chang,3 Yuan-Chieh Yeh1,4 1Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; 2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; 4Program in Molecular Medicine, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Yuan-Chieh Yeh, Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, No. 222, Maijin Road, Anle Dist, Keelung, 204201, Taiwan, Tel +886975362713, Email [email protected] and Objectives: Effective pain and soft tissue management in conservatively treated upper extremity fractures remains challenging. Despite widespread use of traditional Chinese medicine (TCM) topicals for musculoskeletal injuries, robust evidence remains limited. This pilot study evaluated the safety and efficacy of two established TCM formulations during the acute phase of injury.Patients and Methods: In this single-center, four-arm randomized controlled trial (NCT04593849), 24 adults with conservatively managed upper extremity fractures and Tscherne C0 or C1 tissue injuries were allocated to one of four groups: Wan-Yin-Gao-Jia-Jean-Wey (WYGJJW), Ru-Yih-Jin-Huang-Saan (RYJHS), TCM placebo, or control. Treatments were applied daily for 7 days. Feasibility (adherence, compliance) and primary outcomes (limb swelling, adverse skin reactions) were assessed by a blinded evaluator. Pain (VAS) and function (QuickDASH) were secondary outcomes. Non-parametric tests were used for analysis.Results: A total of 24 participants were equally randomized into four study groups, achieving 100% adherence, with no missed doses or clinic visits [retention rate: 100%; drug compliance rate: 100%]. Both WYGJJW and RYJHS groups showed statistical significance in swelling reduction [WYGJJW: 0.95 cm (IQR: 0.9– 1.9); RYJHS: 1.05 cm (0.5– 5.35)], pain relief [WYGJJW: 2 points (0.88– 4.5); RYJHS: 2 (1– 2.25)], and functional improvement [WYGJJW: 7.96 points (2.95– 16.48); RYJHS: 4.39 (2.27– 14.72)]. The WYGJJW group reported fewer skin rashes (16.7%) compared to RYJHS (50.0%), suggesting a more favorable safety profile. When compared to the TCM placebo and control groups, WYGJJW demonstrated significantly greater swelling reduction, and marginally greater functional improvement compared to the TCM placebo group.Conclusion: This study supports the safety, feasibility, and therapeutic potential of integrative TCM medicine for patients with upper extremity fractures and acute musculoskeletal injuries when surgical intervention is not recommended. A larger clinical trial is warranted to confirm these preliminary findings and to further assess long-term clinical effectiveness and safety.Clinicaltrials.gov.id: NCT04593849 was registered on October 9, 2020. Keywords: Ru-Yih-Jin-Huang-Saan (RYJHS), topical traditional Chinese medicine, upper extremity fractures, Wan-Yin-Gao-Jia-Jean-Wey (WYGJJW)