Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound.

Abstract

Sixty-seven closed or grade-I open fractures of the tibial shaft were examined in a prospective, randomized, double-blind evaluation of use of a new ultrasound stimulating device as an adjunct to conventional treatment with a cast. Thirty-three fractures were treated with the active device and thirty-four, with a placebo control device. At the end of the treatment, there was a statistically significant decrease in the time to clinical healing (86 ± 5.8 days in the active-treatment group compared with 114 ± 10.4 days in the control group) (p = 0.01) and also a significant decrease in the time to overall (clinical and radiographic) healing (96 ± 4.9 days in the active-treatment group compared with 154 ± 13.7 days in the control group) (p = 0.0001). The patients' compliance with the use of the device was excellent, and there were no serious complications related to its use. This study confirms earlier animal and clinical studies that demonstrated the efficacy of lowintensity ultrasound stimulation in the acceleration of the normal fracture-repair process. Ultrasound has many medical applications, including therapeutic, operative, and diagnostic procedures '. Both ultrasound therapy and operative ultrasound subject tissue to power levels that are capable of causing ACCELERATION OF TIBIAL FRACTURE-HEALING BY NON-INVASIVE. LOW-INTENSITY PULSED ULTRASOUND 27 VOL. 76.A, NO.

The effects of therapeutic vs. high‐intensity ultrasound on the rabbit growth plate

“…Our study uses a therapeutic dose roughly 10 times the intensity of the ultrasound currently being investigated to accelerate fracture repair [6,7,15]. A study by Spadaro et al [13] demonstrated that application of 30 mW/cm2 ultrasound to growing knee joints in rats showed no significant changes in long bone growth or physeal histology.…”

“…The original studies of the effects of ultrasound on growing bone only utilized high-intensity ultrasound (2-2.5 W/cm2) [3] and recent studies are mainly concerned with using ultrasound doses in the milliwatt range [6,7,13,14]. However, as this study does not follow these animals to physeal closure, it is unclear as to whether the histological changes reported would cause significant growth disturbances following growth plate closure.…”

“…The majority of the current literature has focused on the effects of much lower intensities of ultrasound on bone growth and fracture repair [6,7,13,15]. Our study uses a therapeutic dose roughly 10 times the intensity of the ultrasound currently being investigated to accelerate fracture repair [6,7,15].…”

“…A study by Spadaro et al [13] demonstrated that application of 30 mW/cm2 ultrasound to growing knee joints in rats showed no significant changes in long bone growth or physeal histology. Studies by three different institutes [6,7,15] used this same 30 mW/cm2 dose to measure its effects on fracture healing. Heckman et al [6] found that this dose accelerated healing of tibial diaphyseal fractures in humans.…”

“…Studies by three different institutes [6,7,15] used this same 30 mW/cm2 dose to measure its effects on fracture healing. Heckman et al [6] found that this dose accelerated healing of tibial diaphyseal fractures in humans. Kristiansen et al [7] and Wang et al [15] also demonstrated accelerated healing times of distal radius and femoral fractures using the 30 mW/cm2 dose.…”