Mechanical Monitoring of Fracture Healing Using Ultrasound Imaging

Ricciardi, Luigi; Perissinotto, A; Dabala, Moreno

doi:10.1097/00003086-199308000-00010

Cited by 37 publications

(40 citation statements)

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“…Ultrasound is free of radioactivity that is capable of providing an immediate visualization of structural changes to monitor fracture healing. A previous study using 5 MHz ultrasound had demonstrated the ability to monitor fracture healing processes in humans [33]. Hypoechogenicity was found in the areas over the bone gap during the hematoma phase and also upon the initiation of the soft callus formation phase.…”

Section: Discussionmentioning

confidence: 99%

Monitoring tissue inflammation and responses to drug treatments in early stages of mice bone fracture using 50MHz ultrasound

et al. 2014

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Bone fracture induces moderate inflammatory responses that are regulated by cyclooxygenase-2 (COX-2) or 5-lipoxygenase (5-LO) for initiating tissue repair and bone formation. Only a handful of non-invasive techniques focus on monitoring acute inflammation of injured bone currently exists. In the current study, we monitored in vivo inflammation levels during the initial 2 weeks of the inflammatory stage after mouse bone fracture utilizing 50 MHz ultrasound. The acquired ultrasonic images were correlated well with histological examinations. After the bone fracture in the tibia, dynamic changes in the soft tissue at the medial-posterior compartment near the fracture site were monitored by ultrasound on the days of 0, 2, 4, 7, and 14. The corresponding echogenicity increased on the 2nd, 4th, and 7th day, and subsequently declined to basal levels after the 14th day. An increase of cell death was identified by the positive staining of deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) assay and was consistent with ultrasound measurements. The increases of both COX-2 and Leukotriene B4 receptor 1 (BLT1, 5- LO-relative receptor), which are regulators for tissue inflammation, in the immunohistochemistry staining revealed their involvement in bone fracture injury. Monitoring the inflammatory response to various non-steroidal anti-inflammatory drugs (NSAIDs) treatments was investigated by treating injured mice with a daily oral intake of aspirin (Asp), indomethacin (IND), and a selective COX-2 inhibitor (SC-236). The Asp treatment significantly reduced fracture-increased echogenicity (hyperechogenicity, p < 0.05) in ultrasound images as well as inhibited cell death, and expression of COX-2 and BLT1. In contrast, treatment with IND or SC-236 did not reduce the hyperechogenicity, as confirmed by cell death (TUNEL) and expression levels of COX-2 or BLT1. Taken together, the current study reports the feasibility of a noninvasive ultrasound method capable of monitoring post-fracture tissue inflammation that positively correlates with histological findings. Results of this study also suggest that this approach may be further applied to elucidate the underlying mechanisms of inflammatory processes and to develop therapeutic strategies for facilitating fracture healing.

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Section: Discussionmentioning

confidence: 99%

Monitoring tissue inflammation and responses to drug treatments in early stages of mice bone fracture using 50MHz ultrasound

et al. 2014

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“…Ultrasonography possesses the advantage of being a noninvasive and radiation-free method for this. Studies have shown that more than conventional radiographs, ultrasound with power Doppler clearly reveals healing of fractures along with details of the improvement in vascularity in the affected bone (1,2). These studies prove that high-resolution ultrasound is a very useful tool for monitoring bone healing.…”

mentioning

confidence: 80%

“…These applications are further enhanced by its high-end aspects of color power Doppler to assess blood flow, three-dimensional imaging, and detection of tissue harmonics for improved resolution. Apart from its use as a diagnostic tool, ultrasound is also used in orthopedics for monitoring the healing of fractured bones (1)(2)(3). Ultrasonography possesses the advantage of being a noninvasive and radiation-free method for this.…”

mentioning

confidence: 99%

Efficacy of Ultrasound and Color Power Doppler as a Monitoring Tool in the Healing of Endodontic Periapical Lesions

Nivedha

Balagopal

2007

Journal of Endodontics

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“…In contrast to these studies, Gill et al (3) reported that the speed of sound did not correlate with the mechanical properties of healing fractures in rabbits. Ultrasound also has been used as an imaging tool for evaluation of fracture healing (20,21). Ricciardi et al (20) studied 239 patients with fractures and reported a direct correlation between ultrasonographic changes within the fracture and the calcification of the periosteal callus.…”

Section: Discussionmentioning

confidence: 99%

Atrophic nonunion can be predicted with dual energy x‐ray absorptiometry in a canine ostectomy model

Markel

Bogdanske

Xiang

et al. 1995

Journal Orthopaedic Research

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This study demonstrated that dual energy x-ray absorptiometry can be used to distinguish between normal union and atrophic nonunion, with high sensitivity and high negative predictive value, by 8 weeks after surgery in a canine model. Eighteen adult mixed-breed dogs were divided into two equal groups: normal union and atrophic nonunion. In the normal union group, a 5 mm mid-diaphyseal transverse ostectomy was performed in the right tibia, and the bone was stabilized with a unilateral external fixator. In the atrophic nonunion group, a 5 mm mid-diaphyseal ostectomy was performed; the distal 1.5 cm of the bone ends, including the periosteum, were frozen twice to -20 degrees C using liquid nitrogen and thawed slowly twice; and the bone was stabilized with a unilateral external fixator. The members of the research team were blinded to the group assignments until after all dogs were killed and all data were acquired. Radiography and dual energy x-ray absorptiometry of both tibiae were performed at weeks 1, 2, 3, 4, 6, 8, 10, 12, 14, and 16 after surgery. All dogs were killed at 16 weeks, and the torsional stiffness and maximum torque of both tibiae of five dogs in each group were determined. Mechanically, the tibiae in the normal union group had significantly higher maximum torque (43-fold higher) and torsional stiffness (86-fold higher) than the tibiae in the atrophic nonunion group. The sensitivity and negative predictive value of dual energy x-ray absorptiometry for predicting nonunion were 100% by 8 weeks after surgery. The specificity and positive predictive value reached 78 and 82%, respectively, by 16 weeks. Radiographic scores were significantly higher for the union group than for the nonunion group beginning at 2 weeks after surgery. The earliest time after surgery that radiography classified an ostectomy as a nonunion was significantly later (4.6 +/- 1.2 weeks) than for dual energy x-ray absorptiometry (2.6 +/- 1.4 weeks). Before these results can be extrapolated to human applications, further animal studies must be performed to evaluate clinically or experimentally induced fractures, or both, rather than the well defined ostectomies that were performed in this study.

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Mechanical Monitoring of Fracture Healing Using Ultrasound Imaging

Cited by 37 publications

References 0 publications

Monitoring tissue inflammation and responses to drug treatments in early stages of mice bone fracture using 50MHz ultrasound

Monitoring tissue inflammation and responses to drug treatments in early stages of mice bone fracture using 50MHz ultrasound

Efficacy of Ultrasound and Color Power Doppler as a Monitoring Tool in the Healing of Endodontic Periapical Lesions

Atrophic nonunion can be predicted with dual energy x‐ray absorptiometry in a canine ostectomy model

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