Facilitation of fracture repair using low-intensity pulsed ultrasound

SummaryA recent application of ultrasound (US) therapy is to bone fractures. In two randomized controlled trials in humans, specific dosed US accelerated fresh tibial and radial fracture repair by 38%. When applied to delayed- and non-unions the same dosed US resulted in union in over 80% of cases. Similar US may augment fracture repair in veterinary practice. This paper reviews US dosages applied during fracture repair and their effect on bone healing. It concludes by discussing the clinical and practical implications of these findings to veterinary practice and the need for further research into this electrotherapeutic modality.Low-intensity pulsed ultrasound has been shown to facilitate fresh fracture repair, reduce the incidence of delayed-union and initiate healing of fractures displaying delayedand non-union. This paper discusses these findings and their implications to veterinary practice.

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Evaluating the Effectiveness of Biophysical Methods of Osteogenesis Stimulation: Review

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2021-27-1-86-96 ◽

2021 ◽

Vol 27 (1) ◽

pp. 86-96

Author(s):

V. Yu. Emelianov ◽

E. V. Preobrazhenskaia ◽

N. S. Nikolaev

Keyword(s):

Direct Current ◽

Bone Mineralization ◽

Electrical Coupling ◽

Delayed Union ◽

Pulsed Ultrasound ◽

Non Union ◽

Low Intensity Pulsed Ultrasound ◽

Low Intensity ◽

Correct Location ◽

Pulsed Electromagnetic

Background. Stimulation of osteogenesis (SO) by biophysical methods has been widely used in practice to accelerate healing or stimulate the healing of fractures with non-unions, since the middle of the XIX century. SO can be carried out by direct current electrostimulation, or indirectly by low-intensity pulsed ultrasound, capacitive electrical coupling stimulation, and pulsed electromagnetic field stimulation. SO simulates natural physiological processes: in the case of electrical stimulation, it changes the electromagnetic potential of damaged cell tissues in a manner similar to normal healing processes, or in the case of low-intensity pulsed ultrasound, it produces weak mechanical effects on the fracture area. SO increases the expression of factors and signaling pathways responsible for tissue regeneration and bone mineralization and ultimately accelerates bone union.The purpose of this review was to present the most up-to-date data from laboratory and clinical studies of the effectiveness of SO.Material and Methods. The results of laboratory studies and the final results of metaanalyses for each of the four SO methods published from 1959 to 2020 in the PubMed, EMBASE, and eLibrary databases are reviewed.Conclusion. The use of SO effectively stimulates the healing of fractures with the correct location of the sensors, compliance with the intensity and time of exposure, as well as the timing of use for certain types of fractures. In case of non-union or delayed union of fractures, spondylodesis, arthrodesis, preference should be given to non-invasive methods of SO. Invasive direct current stimulation can be useful for non-union of long bones, spondylodesis with the risk of developing pseudoarthrosis.

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Outcomes of Exogen low-intensity pulsed ultrasound in the management of delayed union following elective foot and ankle surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00420 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0042

Author(s):

Ashley Scrimshire ◽

Paulo Torres ◽

Michal Koziara ◽

Jack Allport

Keyword(s):

Smoking Status ◽

Corrective Osteotomy ◽

Delayed Union ◽

Foot And Ankle ◽

Union Rate ◽

Pulsed Ultrasound ◽

Non Union ◽

Low Intensity Pulsed Ultrasound ◽

Low Intensity ◽

Ankle Surgery

Category: Basic Sciences/Biologics Introduction/Purpose: Exogen low-intensity pulsed ultrasound therapy is well established in the management of fracture delayed or non-union. Its use in trauma has recently been recommended by the National Institute for Clinical Excellence in England. In comparison the use of Exogen for managing delayed union following elective foot and ankle surgery has not previously been reported in the literature. We aim to review the indications for and outcomes following Exogen therapy for managing delayed union following elective foot and ankle surgery in our English tertiary referral centre. Methods: Case notes and imaging were reviewed for all patients receiving Exogen therapy following elective foot and ankle surgery from July 2012 - July 2017 in our centre. Data were collected on patient demographics, smoking status, comorbidities, indications for and type of surgery performed, duration of Exogen therapy and final outcomes. Union was confirmed radiologically and clinically. Results: 58 patients were included, 18 smokers and 8 diabetic. The mean age was 55 years. 50 underwent an arthrodesis, 8 an osteotomy. Exogen was started a mean of 244-days post-operatively. 24 patients went on to complete union; a further 7 were showing good progress towards union. When grouped together the union rate was 53.4% (n=31). Complete union took a mean of 177-days (range 44–441). The non-union rate was 46.6% (n=27) despite a mean of 330-days treatment (range 72–1112). 1 was complicated by infection. There were no significant differences in age, time to commencing Exogen, number of smokers or diabetics between the groups. The non-union group had significantly longer treatment (p=0.003). Union was more likely following an osteotomy (n=6/8,75%) or surgery to the hindfoot (n=6/7,86%). Conclusion: We have found Exogen can be beneficial in managing delayed union following elective foot and ankle surgery for over half of patients. This can potentially reduce the number of revision surgeries required. We found no correlation between patient age, smoking or diabetes in outcome. Union was more likely following a corrective osteotomy or surgery to the hindfoot. This data can help inform clinicians in their decision-making and in counselling patients.

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