Low Intensity Pulsed Ultrasound - Callum Clark 1/11/2001

 

 

Brief

Nolte et al

J Trauma

2001

Title

Low-Intensity Pulsed Ultrasound in the Treatment of Nonunions

Authors

Nolte PA, van der Krans A, Patka P, Janssen IMC, Ryaby JP, Albers GH

Reference

  J Trauma 2001;51(4):693-703

Summary

  41 nonunions, 12 excluded – 29 treated. Mixture of bones and hypertrophic / atrophic. All treated with Exogen stimulator. 86% (25 of 29) healed in 5/12. Smoking is bad. Hypertrophic = atrophic. 100% tibia, 80% others.

Critique

Variety of bones. Only waited 3/12 for atrophic nonunions before Exogen. Only 75% compliance. 4 excluded for lack of compliance

 

 

 

 

Brief

Heckman et al

JBJS (Am)

1994

Title

Acceleration of Tibial # Healing by non-invasive Low Intensity Pulsed Ultrasound

Authors

Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF

Reference

  JBJS 1994; 76-A(1):26-34

Summary

Multi-centre PRCT. Closed or Grade I open tibial #. 97 eligible –67 pts in study. Well matched groups. Started treatment 7/7 post-# through POP window. Clinical and Xray end-points. Treatment group – 96 days vs Control – 154 days. P=0.0001

 

Critique

 

13/97 lost to follow-up and 17/97 excluded, but well-designed PRCT.

 

 

 

 

Brief

Goodship and Kenwright

JBJS (Br)

1985

Title

The Influence of induced micromovement on the healing of experimental tibial #

Authors

Goodship AE, Kenwright J

Reference

JBJS 1985; 67-B(4):650-55

Summary

12 sheep – osteotomised right tibia and exfix with 3cm distraction. 6 had rigid fixation, 6 had 1mm longitudinal axial cyclical compression (17mins/day). Found increased early callus, torsional stiffness and bridging post-mortem in group 2. Postulated that mechanical stimulus and micromovement in first few days/weeks are crucial to # healing.

Critique

Controlled osteotomies, not #. Layed groundwork for modern thinking on # healing.

 

N.B - CORR 355 Supplement (1998) “#Healing Enhancement”

        - Kristiansen et al JBJS 1997; 79-A(7):961-73 (PRDBCT on distal radial #)

 

 

 

# Healing stages

                           1/ Inflammatory

                           2/ Reparative -    stem cells to fibroblasts, chondroblasts, osteoblasts

                                                      angiogenesis

                                                      mineralisation to woven bone

                           3/ Remodelling

 

10 % of # go to delayed union (>3/12)

 

Nonunion = “>9/12”, Healing has stopped, “No established nonunion will unite with conservative treatment alone” (Watson-Jones)

 



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