Low-intensity pulsed ultrasound: Effects on nonunions

Gebauer, D; Mayr, Edgar; Orthner, E.; Ryaby, John P.

doi:10.1016/j.ultrasmedbio.2005.06.002

Cited by 185 publications

(128 citation statements)

References 41 publications

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“…Only 10.2% of patients were coded as past or current smokers (Table 1), whereas 18% of the general population is expected to smoke 12 and other nonunion cohort studies have reported a prevalence of smoking higher than the US average. 13 Similarly, we may underestimate obesity prevalence; only diagnosed obesity was analyzed, so many people with nonunion fractures may have been obese but we have no record of it. Lack of convergence of the model was a rare problem (Tables 4 and 5) except for coagulants, which appear to be rarely used among patients with fractures ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

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IMPORTANCE Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors.OBJECTIVE To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion.DESIGN, SETTING, AND PARTICIPANTS An inception cohort study in a large payer database of patients with fracture in the United States was conducted using patient-level health claims for medical and drug expenses compiled for approximately 90.1 million patients in calendar year 2011. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology codes; comorbidities as per International Classification of Diseases, Ninth Revision codes; and drug prescriptions as per National Drug Code Directory codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion. Data analysis was performed from January 1, 2011, to December 31, 2012, EXPOSURES Continuous enrollment in the database was required for 12 months after fracture to allow sufficient time to capture a nonunion diagnosis. RESULTSThe final analysis of 309 330 fractures in 18 bones included 178 952 women (57.9%); mean (SD) age was 44.48 (13.68) years. The nonunion rate was 4.9%. Elevated nonunion risk was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Women experienced more fractures, but men were more prone to nonunion. The nonunion rate also varied with fracture location: scaphoid, tibia plus fibula, and femur were most likely to be nonunion. The ORs for nonunion fractures were significantly increased for risk factors, including number of fractures (OR, 2.65; 95% CI, 2.34-2.99), use of nonsteroidal anti-inflammatory drugs plus opioids (OR, 1.84; 95% CI, 1.73-1.95), operative treatment (OR, 1.78; 95% CI, 1.69-1.86), open fracture (OR, 1.66; 95% CI, 1.55-1.77), anticoagulant use (OR, 1.58; 95% CI, 1.51-1.66), osteoarthritis with rheumatoid arthritis (OR, 1.58; 95% CI, 1.38-1.82), anticonvulsant use with benzodiazepines (OR, 1.49; 95% CI, 1.36-1.62), opioid use (OR, 1.43; 95% CI, 1.34-1.52), diabetes (OR, 1.40; 95% CI, 1.21-1.61), high-energy injury (OR, 1.38; 95% CI, 1.27-1.49), anticonvulsant use (OR, 1.37; 95% CI, 1.31-1.43), osteoporosis (OR, 1.24; 95% CI, 1.14-1.34), male gender (OR, 1.21; 95% CI, 1.16-1.25), insulin use (OR, 1.21; 95% CI, 1.10-1.31), smoking (OR, 1.20; 95% CI, 1.14-1.26), benzodiazepine use (OR, 1.20; 95% CI, 1.10-1.31), obesity (OR, 1.19; 95% CI, 1.12-1.25), antibiotic use (OR, 1.17; 95% CI, 1.13-1.21), osteoporosis medication use (OR, 1.17; 95% CI, 1.08-1.26), vitamin D deficiency (OR, 1.14; 95% CI, 1.05-1.22), diuretic use (OR, 1.13; 95% CI, 1.07-1.18), and renal insufficiency (OR, 1.11; 95% CI, 1.04-1.17) (multivariate P < .001 for all).C...

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Section: Resultsmentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

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“…Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that transmitted into connective tissues as an acoustic wave. As a non-invasive therapy, LIPUS has been used to promote fracture healing for 30 years, and is studied and applied in many clinical studies [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…It has been proved that LIPUS can promote formation of the medullary canal and cortex in a gap-healing model, which then leads to earlier restoration of the structural integrity of the healing site 11 . Many clinical studies indicate that LIPUS can enhance the healing of fresh fractures, delayed unions, nonunions, distraction osteogenesis and congenital pseudoarthroses 7,8,12,13 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound treatment for accelerating fracture healing of the distal radius. A control study

Liu¹,

Wei²,

Kuang³

et al. 2014

Acta Cir. Bras.

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PURPOSE:To investigate the accelerating effects of low-intensity pulse ultrasound stimulation (LIPUS) on the fracture healing of distal radius. METHODS:A total of 81 patients with distal radius fracture were randomly divided into two groups: the ultrasound treatment group and the control group. Patients in the ultrasound treatment group were immobilized in a below-elbow cast and received LIPUS treatment 15 min/day, while the control group were immobilized by a plaster support and cast. The patients were followed up every week and took X-ray films. The initial and healed X-ray films and the gray value of fracture site were analyzed by Photoshop software. The effect of reposition was evaluated based upon Steward recommended by Dienst, combining with Aro's measuring method. RESULTS:Clinical fracture healing time in ultrasound group was significantly shorter than that in the control group (32.04 ± 2.58d vs.40.75 ± 5.12d, p <0.01). In addition, the grey value changes of fracture sites of the ultrasound group were much higher than that of the control group. The reposition effects of fracture healing had no difference between the two groups (p >0.05). CONCLUSION:Low-intensity pulse ultrasound stimulation could accelerate fracture healing of the distal radius and promote local bone formation.

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“…Similarly, Gebauer et al reported on 67 nonunions, including six scaphoid nonunions, treated with ultrasound therapy. 1 Healing occurred in 85% of the patients without additional surgical treatment. Rubin et al analyzed ultrasound prescription registry data to examine the effects of ultrasound on nonunion.…”

mentioning

confidence: 99%

“…The safety and efficacy of low-intensity pulsed ultrasound in the treatment of fracture nonunion has been previously investigated, [1][2][3][4][5][6] and this technology is approved in the United States by the Food and Drug Administration (FDA) for treatment of fracture nonunion in adults. Several recent studies of this adjunctive treatment modality have included a percentage of scaphoid fractures.…”

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confidence: 99%

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

et al. 2015

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).Attempts by clinicians to maximize the healing potential of nonunions have led to the use of adjunctive treatment modalities such as low-intensity pulsed ultrasound therapy. The safety and efficacy of low-intensity pulsed ultrasound in the treatment of fracture nonunion has been previously investigated, 1-6 and this technology is approved in the United States by the Food and Drug Administration (FDA) for treatment of fracture nonunion in adults. Several recent studies of this adjunctive treatment modality have included a percentage of scaphoid fractures. Nolte et al reported on 29 cases of established fracture nonunion in a variety of anatomic locations, including five scaphoid fractures. 3 The majority of these cases were treated with prior surgery. Following failure of treatment, the nonunions were subjected to ultrasound therapy; 86% went on to healing in a mean time of 22 weeks. Of the scaphoid nonunions, four out of five demonstrated healing at a mean interval of 143 days. Similarly, Gebauer et al reported on 67 nonunions, including six scaphoid nonunions, treated with ultrasound therapy. 1 Healing occurred in 85% of the patients without additional surgical treatment. Rubin et al analyzed ultrasound prescription registry data to examine the effects of ultrasound on nonunion. 4 The registry subcategorized fracture nonunion by anatomic location, and the reviewing authors found that 101 out of 118, or 86%, of scaphoid fracture nonunions healed following ultrasound therapy. Rubin et al did not assess the registry data for other Keywords ► scaphoid fracture ► scaphoid nonunion ► pulsed ultrasound ► adolescents ► adjunctive therapy AbstractBackground Treatment of scaphoid nonunion is challenging, leading clinicians to pursue innovation in surgical technique and adjunctive therapies to improve union rates. Purpose The purpose of this study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive treatment modality following surgical treatment of scaphoid nonunion in adolescent patients, for whom this therapy has not yet been FDA-approved. Patients and MethodsWe performed a retrospective review of adolescent patients with scaphoid nonunion treated surgically followed by adjunctive low-intensity pulsed ultrasound therapy. All patients underwent 20 minutes of daily ultrasound therapy postoperatively until there was evidence of bony healing, based on both clinical and radiographic criteria. Final healing was confirmed by > 50% bone bridging on CT scan. Results Thirteen of fourteen (93%) patients healed at a mean interval of 113 days (range 61-217 days). There were no surgical or postoperative complications. One patient developed heterotopic bone formation about the scaphoid. Conclusions Our study suggests that low-intensity pulsed ultrasound therapy can safely be utilized as an adjunctive modality in adolescents to augment scaphoid healing following surgical intervention. Level of Evidence Level IV, Case series

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Low-intensity pulsed ultrasound: Effects on nonunions

Cited by 185 publications

References 41 publications

Epidemiology of Fracture Nonunion in 18 Human Bones

Epidemiology of Fracture Nonunion in 18 Human Bones

Ultrasound treatment for accelerating fracture healing of the distal radius. A control study

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

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