CISSUS QUADRANGULARIS AS AN ADJUVANT TO CALCIUM SUPPLEMENTATION IN LONG-BONE FRACTURE HEALING: A PROSPECTIVE COMPARATIVE STUDY

Background: Fractures represent a large public health problem worldwide. The basic treatment is to use calciumsupplementation which is common practice. However, this approach may not fully meet the requirement in terms of themultifactorial factors that play a role in fracture healing. Cissus quadrangularis (CQ) is an ancient herbal plant that hasdocumented osteogenic, anti-inflammatory and antioxidant effects, and has demonstrated early clinical efficacy. Highquality prospective comparative evidence comparing CQ when administered jointly with calcium with calcium alone inlong-bone fractures is not available and further especially from Indian population. Materials and Methods: We conducted aprospective, open-label, comparative study at a tertiary care orthopaedic centre in Hyderabad, India. A total of 80 patientswith radiologically proved long-bone fracture were randomized to receive: (Group 1) Cissus Quadrangularis 500 mg (twicetimes daily) combined with elemental calcium 500 mg (twice daily) or (Group 2) calcium 500 mg (twice daily) alone for 12weeks. The primary outcome was a radiological fracture healing by Lane and Sandhu scoring system at 4, 8 and 12 weeks.Secondary outcomes included pain intensity (Numeric Rating Scale 0–10), lower-limb function (Lower ExtremityFunctional Scale, LEFS), upper-limb function (Disabilities of the Arm, Shoulder and Hand, DASH) and mean time toradiographic union. Within group(s) and between group(s) comparisons were performed using repeated-measures analysis ofvariance (RM-ANOVA) with Pillai's Trace. Results: Baseline Lane and Sandhu scores were comparable (Group 1: 0.50 ±0.51; Group 2: 0.53 ± 0.51; p = 0.826). Group 1 demonstrated significantly higher radiological scores at 4 weeks (3.18 ±0.78 vs 1.40 ± 0.50), 8 weeks (6.65 ± 1.37 vs 3.50 ± 1.04), and 12 weeks (10.35 ± 1.56 vs 7.13 ± 1.62) (all p < 0.001). Meantime to radiographic union was shorter in Group 1 (10.35 ± 1.56 vs 12.00 ± 0.00 weeks; p < 0.001). The NRS pain scores ofGroup 1 were significantly lower than those of Group 2 since week 4 onwards (p ≤ 0.005). At all follow up dates, the scoresof LEFS were better in Group 1 (p < 0.05). There were similar improvements in scores on DASH in both groups. It wasfound that there were strong negative correlations between Lane, Sandhu scores and NRS at 12 weeks (r = −0.703, p <0.001). No significant adverse events were noted. Conclusion: When combined with calcium supplementation, CQsignificantly increases lower-limb functional recovery, decreases pain and enhances radiological fracture healing thancalcium alone. This combination is well tolerated and provides a rational and cost-accessible approach for integrativefracture management. There is a need for larger RCTs.