The Use of Low-Intensity Ultrasound to Accelerate the Healing of Fractures

Rubin, Clinton T.; Bolander, Mark E.; Ryaby, John P.; Hadjiargyrou, Michael

doi:10.2106/00004623-200102000-00015

Cited by 332 publications

(237 citation statements)

References 32 publications

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“…The protein expression of BMP-2 in the control group (15 ± 2; 95% CI, 14-16) was lower (p \ 0.001) than in the LIPUS group (30 ± 3; 95% CI, 28-31). However, VEGF mRNA expression was not different (p = 0.114; Table 2) between the LIPUS group (28 ± 2; 95% CI, [26][27][28][29] and the control group (26 ± 3; 95% CI, [24][25][26][27][28]. VEGF protein expression also was not different (p = 0.0124, Fig.…”

Section: Bmp-2 and Vegf Expressionmentioning

confidence: 90%

“…It has been approved by the FDA as a feasible, cost-effective method for treating delayed union and/or nonunion of bone fractures. The benefits of LIPUS have been documented during all stages of bone repair, including osteogenesis, angiogenesis, and chondrogenesis [28,29]. In vitro studies have shown that LIPUS increases bone formation, osteoblast activity, and osteogenic differentiation of mesenchymal stem cells (MSCs) [27,31].…”

Section: Introductionmentioning

confidence: 99%

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Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Zhu

Cai

Lin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Steroids are a leading cause of femoral head osteonecrosis. Currently there are no medications available to prevent and/or treat steroid-associated osteonecrosis. Low-intensity pulsed ultrasound (LIPUS) was approved by the FDA for treating delayed union of bone fractures. Some studies have reported that LIPUS can enhance bone formation and local blood flow in an animal model of fracture healing. However, whether the effect of osteogenesis and neovascularization by LIPUS can enhance the repair progress in steroid-associated osteonecrosis is unknown.Questions/purposes We hypothesized that LIPUS may facilitate osteogenesis and neovascularization in the reparative processes of steroid-associated osteonecrosis. Using a rabbit animal model, we asked whether LIPUS affects (1) bone strength and trabecular architecture; (2) blood vessel number and diameter; and (3) BMP-2 and VEGF expression. Methods Bilateral femoral head necrosis was induced by lipopolysaccharide and methylprednisolone in 24 rabbits. The left femoral heads of rabbits received LIPUS therapy (200 mW/cm 2 ) for 20 minutes daily and were classified as the LIPUS group. The right femoral heads of the same rabbits did not receive therapy and were classified as the control group. All rabbits were euthanized 12 weeks after LIPUS therapy. Micro-CT, biomechanical testing, histologic evaluation, immunohistochemistry, quantitative realtime PCR, and Western blot were used for examination of the effects of LIPUS. Results Twelve weeks after LIPUS treatment, the loading strength in the control group was 355 ± 38 N (95% CI, 315-394 N), which was lower (p = 0.028) than that in the LIPUS group (441 ± 78 N; 95% CI, 359-524 N). The bone tissue volume density (bone volume/total volume) in the LIPUS group (49.29% ± 12.37%; 95 % CI, 36.31%-62.27%) was higher (p = 0.022) than that in the control group (37.93% ± 8.37%; 95 % CI, 29.15%-46.72%). The percentage of empty osteocyte lacunae in the LIPUS group (17% ± 4%; 95% CI, 15%-20%) was lower (p = 0.002) than that in the control group (26% ± 9%; 95% CI, 21%-32%). The mineral apposition rate (lm/day) in the LIPUS group (2.3 ± 0.8 lm/day; 95% CI, 1.8 2.8 lm/day) was higher (p = 0.001) than that in the control group (1.6 ± 0.3 lm/day; 95% CL, 1.4-1.8 lm/day). The number of blood vessels in the LIPUS group (7.8 ± 3.6/mm 2 ; 95% CI, 5.5-10.1 mm 2 ) was greater (p = 0.025) than the number in Hanxiao Zhu and Xunzi Cai contributed equally to this work and should be considered as co-first authors.The institution of the authors has received funding from the National Natural Science Foundation of China (Hangzhou, Zhejiang, China) (81101377, 81101345, 81171687, 81371954, 81201414, 81201416, 81401785, 81472113) 123Clin Orthop Relat Res (2015) 473:1830-1839 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® the control group (5.7 ± 2.6/mm 2 ; 95% CI, 4.0-7.3 mm 2 ). Messenger RNA (mRNA) and protein expression of BMP-2 in the LIPUS group (75 ± 7, 95% CI, 70-7...

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Section: Bmp-2 and Vegf Expressionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Zhu

Cai

Lin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…The first successful application of LIPUS for human nonunions was demonstrated in 1983 in a study that reported healing in 70% of 26 fractures [15]. In 1994 and 2000, the FDA approved ultrasound for accelerating the healing of acute fractures and existing nonunions [11].…”

mentioning

confidence: 99%

Cochrane in CORR ®: Ultrasound and Shockwave Therapy for Acute Fractures in Adults (Review)

Aleem

Bhandari

2016

Clinical Orthopaedics &Amp; Related Research

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“…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…”

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.…”

mentioning

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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The Use of Low-Intensity Ultrasound to Accelerate the Healing of Fractures

Cited by 332 publications

References 32 publications

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Cochrane in CORR ®: Ultrasound and Shockwave Therapy for Acute Fractures in Adults (Review)

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

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