scholarly journals Union of foot/ankle Arthrodesis: A Registry Study of Low-intensity Pulsed Ultrasound (LIPUS)

2021 ◽  
Author(s):  
Neil White ◽  
Johnny Lau ◽  
Kevin Ong ◽  
Steven Kurtz ◽  
Sheldon Lin
Keyword(s):  
Risk Factors ◽  
Treatment Success ◽  
Ankle Arthrodesis ◽  
Current Smoker ◽  
Primary Group ◽  
Union Rate ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity

Abstract Background: Bone grafts and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis to improve healing and reduce revision risk. Union rates of low-intensity pulsed ultrasound (LIPUS) and the factors associated with improved healing were evaluated. Methods: From a prospective arthrodesis/fracture registry for EXOGEN (Bioventus LLC), treatment success for foot/ankle arthrodesis patients were was evaluated, based on both clinical (solid and pain-free on manual stress) and radiological (3 of 4 cortices bridging) criteria. Associations between union rates and surgical treatments, comorbidities, and medications were tested.Results: EXOGEN was used by a total of 235 primary and 16 revision foot/ankle arthrodesis patients. Of these, 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. EXOGEN use within 90 days of the fracture/arthrodesis was associated with improved union rates (overall group (p=0.004, odds ratio (OR) 3.675 (95% CI: 1.459-9.258)); primary group (p=0.007, OR 3.383 (95% CI: 1.335-8.574))). The overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Patients with the comorbidity of diabetes, obesity, or current smoker were not associated with a higher non-union rate (p=0.779). Other comorbidities were not associated with increased non-union rates (Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). For all patients, union rates were 94.2% (EXOGEN use ≤90 days post-fracture/arthrodesis) and 81.6% (>90 days). Conclusions: Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies. Known patient risk factors for non-union were not found to be associated with impaired healing for the LIPUS patients, suggesting the possibility that LIPUS may mitigate these known risk factors.

scholarly journals Union of Foot/Ankle Arthrodesis: A Registry Study of Low-Intensity Pulsed Ultrasound (LIPUS)

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
Neil J. White ◽  
Johnny T. Lau ◽  
Kevin Ong ◽  
Steven M. Kurtz ◽  
Sheldon S. Lin
Keyword(s):  
Risk Factors ◽  
Treatment Success ◽  
Ankle Arthrodesis ◽  
Current Smoker ◽  
X Rays ◽  
Union Rate ◽  
Pulsed Ultrasound ◽  
Chi Square ◽  
Non Union ◽  
Post Market

Category: Ankle; Hindfoot; Midfoot/Forefoot; Trauma. Introduction/Purpose: To aid in healing and avoid costly revision surgery, bone grafts, growth factors, and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis. This study evaluated the union rates of LIPUS as an adjunct to foot/ankle arthrodesis and the corresponding factors associated with improved healing. Methods: Foot/ankle arthrodesis patients were identified retrospectively from a prospective post-market arthrodesis/fracture registry for EXOGEN (Bioventus LLC, Durham, NC). Inclusion criteria were males or non-pregnant females 18 years of age or older at time of enrollment, known date of fracture, known start and end dates of LIPUS treatment, and known treatment success outcome. Treatment success was defined by both clinical (solid and pain-free on manual stress) and radiological (at least 3 of 4 cortices bridged on x-rays) criteria. Association between union rates and surgical treatments, comorbidities, and medications was tested with Chi-square tests. Results: A total of 235 primary and 16 revision foot/ankle arthrodesis patients used EXOGEN. 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. Overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Having the comorbidity of diabetes, obesity, or current smoker was not associated with a higher non-union rate (p=0.779). Other comorbidities were also not associated with increased non-union rates (e.g., Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). EXOGEN use within 90 days of the fracture/procedure date was associated with improved union rates for the overall (p=0.004, odds ratio (OR) 3.7 (95% CI: 1.5-9.3)) and primary (p=0.007, OR 3.4 (95% CI: 1.3-8.6)) groups. For the overall group, union rates were 94.2% (EXOGEN use <=90 days post-fracture/procedure), 80.6% (91 to 365 days), and 84.6% (>365 days). Conclusion: Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies with and without other adjuncts (Table 1). Known risk factors for non-union, such as smoking and Charcot disease, were not found to be associated with healing for the LIPUS patients. This suggests the possibility that LIPUS was able to mitigate potential patient risk factors and may offer a low risk post-operative adjunct in difficult healing scenarios. [Table: see text]

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

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.

Facilitation of fracture repair using low-intensity pulsed ultrasound

2000 ◽  
Vol 13 (04) ◽  
pp. 158-164 ◽  
Author(s):  
W. T. Wong ◽  
K. L. Bennell ◽  
J. M. McMeeken ◽  
J. D. Wark ◽  
S. J. Warden
Keyword(s):  
Bone Fractures ◽  
Delayed Union ◽  
Fracture Repair ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Veterinary Practice ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Fresh Fracture ◽  
Practical Implications

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.

Low-intensity pulsed ultrasound (LIPUS) can decrease the economic burden of fracture non-union

2015 ◽  
Vol 18 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Samir Mehta ◽  
Ken Long ◽  
Mitch DeKoven ◽  
Elise Smith ◽  
R. Grant Steen
Keyword(s):  
Economic Burden ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity

scholarly journals Role of low-intensity pulsed ultrasound on lumbar spondylolysis: a systematic review

2021 ◽  
pp. 1-10
Author(s):  
Fahad Tanveer ◽  
Syed Asadullah Arslan ◽  
Haider Darain ◽  
Ashfaq Ahmad ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Union ◽  
Lumbar Region ◽  
Interventional Ultrasound ◽  
Union Rate ◽  
Pulsed Ultrasound ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity ◽  
Lumbar Spondylolysis

Objective: To systematically review the role of low-intensity pulsed ultrasound on lumbar spondylolysis. Method: Literature search was conducted on PubMed, Embase, CINAHL, Web of Science, PEDro and Scopus databases to identify relevant studies published between 2010 and 2020 by using medical subject headings and applying Booleans, such as low-intensity pulsed ultrasound OR interventional ultrasound AND lumbar spine OR lumbar region AND spondylolysis OR stress fracture. Unpublished studies were hand-searched in the journals, abstracts of conferences were reviewed, and citation index was used for searching experts in the field and then contacting them for information. Studies included were the ones that had at least one of the following outcomes: bone union rate, treatment period to bone union and time to return to previous activities. Results: Of the 243 studies identified, 228(94%) were full text articles and only 2(0.8%) studies were critically appraised for qualitative synthesis based on bone union rate, treatment period to bone union, and time to return to previous activities. Conclusion: Low-intensity pulsed ultrasound was found to be effective for bone union and a useful therapy for quick return to playing sports in patients with lumbar spondylolysis. Key Words: Lumbar region, Spondylolysis, Interventional ultrasound, Systematic review.

scholarly journals Low intensity pulsed ultrasound (LIPUS) use for the management of instrumented, infected, and fragility non-unions: a systematic review and meta-analysis of healing proportions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ross Leighton ◽  
Mark Phillips ◽  
Mohit Bhandari ◽  
Robert Zura
Keyword(s):  
Quality Of Life ◽  
Fragility Fracture ◽  
Literature Search ◽  
Case Series ◽  
Pulsed Ultrasound ◽  
Non Union ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity

Abstract Background Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Low intensity pulsed ultrasound (LIPUS) is a non-invasive therapy for non-union treatment that can improve the long-term outcome. The purpose of this study is to summarize the available literature assessing LIPUS potential to improve the union rate in instrumented, infected, and fragility non-unions. Methods A literature search was conducted in the MEDLINE, EMBASE, and CINAHL databases for all relevant literature on the healing rates of LIPUS utilized in instrumented, infected, and fragility non-unions. Study characteristics were summarized for each of the included studies. The percentage of healed patients (healing rate), for instrumented, infected, and fragility fracture non-union patients were pooled from each included study. Results The literature search identified a total of 326 articles, while searching reference lists and grey literature identified an additional 3 articles. There was a total of 29 articles included in this review, with 20 articles included within the quantitative synthesis of healing rates. The most common design of included studies was case series (17 articles), followed by case reports (9 articles). Studies were primarily retrospective (18 studies), with an additional 10 prospective studies. Non-union healing rates were 82% (95% CI: 76 to 87%) in instrumented, 82% (95% CI: 70 to 95%) in infected, and 91% (95% CI: 87 to 95%) in fragility fracture patients with non-unions. Conclusion This study has provided a thorough overview of the current literature on LIPUS treatment for instrumented, infected, and fragility fracture non-unions. The healing rates for non-unions in these subgroups were comparable to healing rates observed with LIPUS use in general non-union literature. LIPUS treatment should be considered as a conservative non-surgical treatment option to potentially reduce the socioeconomic impact and improve the quality of life of these unfortunate patients. Level of evidence 4 (systematic review of primarily case series data)

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