Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series

Bhan, Kavyansh; Patel, Ronak M.; Hasan, Kamrul; Pimple, M.; Sharma, Sucheta; Nandwana, Varsha; Basta, Mhafrin

doi:10.7759/cureus.17067

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…This included patients who were treated with initial surgical fixation (79% union) as well as patients who were managed conservatively (86% union). This is in keeping with the healing rates according to the data provided by Exogen as well as other recently published studies, whose success rates vary between 78% and 90% [10,[13][14][15]. An example of one of the successfully managed patients with LIPUS therapy can be appreciated in Figures 2-5.…”

Section: Discussionsupporting

confidence: 85%

A Retrospective Study: Is Low-Intensity Pulsed Ultrasound (LIPUS) an Effective Alternate Treatment Option for Non-union?

Pretorius¹,

Mohamed²,

Mustafa³

et al. 2022

Cureus

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BackgroundThere is ongoing controversy regarding the use of low-intensity pulsed ultrasound (LIPUS) therapy in patients with delayed union or non-union. Exogen (Bioventus, Durham, NC) is a well-known brand of LIPUS, and according to their data, 86% of non-union fractures will heal without the need for surgery. A few independent retrospective studies reported much lower healing rates. MethodA retrospective observational study was performed assessing all the patients who underwent Exogen therapy in a single centre. All patients who were initiated on Exogen after three months with radiographic signs of the delayed union were included in the study. Routine follow-up appointments were organised until clinical and radiological healing could be confirmed. Daily 20-minute Exogen sessions were continued until the fracture was healed or up to a maximum of four months as recommended by the manufacturer. ResultsA total of 37 patients received Exogen therapy from 2012 to 2021, of which only 28 patients met our inclusion criteria and were subsequently analysed. The mean age of the patients was 52.0 (SD ± 20.2) with a male to female ratio of 1.7:1. The average time to healing was 115 (±51.2) days with a success rate of 82.14%. The average interfragmentary gap was 7.5 mm (±5.8) for the fractures that healed whereas the failed treatment was 16.1 mm (±13.8). There was no obvious association between outcomes after Exogen therapy and the patient's age, sex, time to initiate Exogen, diabetes, and smoking status. ConclusionThis study demonstrated a high success rate of LIPUS therapy for patients with delayed union and nonunion. LIPUS represents a safe, non-invasive alternative to revision surgery. An independent risk factor for a potentially poor outcome is an increased interfragmentary gap.

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Section: Discussionsupporting

confidence: 85%

A Retrospective Study: Is Low-Intensity Pulsed Ultrasound (LIPUS) an Effective Alternate Treatment Option for Non-union?

Pretorius¹,

Mohamed²,

Mustafa³

et al. 2022

Cureus

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“…The overall healing rate of LIPUS for hypertrophic and atrophic bone discontinuity patients is 86.7 and 63.5% 30 . Though typically applied as an alternative to surgical treatment for nonunion and delayed healing, 38 LIPUS should be considered together with other treatments in situations of large fracture gaps and instability 30 . Tobacco affects bone metabolism, and smoking is a significant pathological component of fracture non‐union 39 .…”

Section: Lipus In Fracture Healingmentioning

confidence: 99%

Latest Progress of LIPUS in Fracture Healing

Guo,

Lv,

Lin

et al. 2024

J of Ultrasound Medicine

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The use of low‐intensity pulsed ultrasound (LIPUS) for promoting fracture healing has been Food and Drug Administration (FDA)‐approved since 1994 due to largely its non‐thermal effects of sound flow sound radiation force and so on. Numerous clinical and animal studies have shown that LIPUS can accelerate the healing of fresh fractures, nonunions, and delayed unions in pulse mode regardless of LIPUS devices or circumstantial factors. Rare clinical studies show limitations of LIPUS for treating fractures with intramedullary nail fixation or low patient compliance. The biological effect is achieved by regulating various cellular behaviors involving mesenchymal stem/stromal cells (MSCs), osteoblasts, chondrocytes, and osteoclasts and with dose dependency on LIPUS intensity and time. Specifically, LIPUS promotes the osteogenic differentiation of MSCs through the ROCK‐Cot/Tpl2‐MEK–ERK signaling. Osteoblasts, in turn, respond to the mechanical signal of LIPUS through integrin, angiotensin type 1 (AT1), and PIEZO1 mechano‐receptors, leading to the production of inflammatory factors such as COX‐2, MCP‐1, and MIP‐1β fracture repair. LIPUS also induces CCN2 expression in chondrocytes thereby coordinating bone regeneration. Finally, LIPUS suppresses osteoclast differentiation and gene expression by interfering with the ERK/c‐Fos/NFATc1 cascade. This mini‐review revisits the known effects and mechanisms of LIPUS on bone fracture healing and strengthens the need for further investigation into the underlying mechanisms.

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“…LIPUS has also been used in clinical trials for fracture healing, and compelling clinical data demonstrate its effectiveness in bone fracture healing, especially in some high-risk non-union cases that are not suitable for surgery (Zura et al, 2015a;Rutten et al, 2016;Leighton et al, 2017;Bhan et al, 2021). Former studies have demonstrated that LIPUS is responsible for accelerating bone reparations through both upregulating osteogenic-specific genes and downregulating osteoclast differentiation (Costa et al, 2018;Meng et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

LIPUS as a potential strategy for periodontitis treatment: A review of the mechanisms

Aimaijiang

Liu²,

Zhang³

et al. 2023

Front. Bioeng. Biotechnol.

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Periodontitis is a chronic inflammatory condition triggered by oral bacteria. A sustained inflammatory state in periodontitis could eventually destroy the alveolar bone. The key objective of periodontal therapy is to terminate the inflammatory process and reconstruct the periodontal tissues. The traditional Guided tissue regeneration (GTR) procedure has unstable results due to multiple factors such as the inflammatory environment, the immune response caused by the implant, and the operator’s technique. Low-intensity pulsed ultrasound (LIPUS), as acoustic energy, transmits the mechanical signals to the target tissue to provide non-invasive physical stimulation. LIPUS has positive effects in promoting bone regeneration, soft-tissue regeneration, inflammation inhibition, and neuromodulation. LIPUS can maintain and regenerate alveolar bone during an inflammatory state by suppressing the expression of inflammatory factors. LIPUS also affects the cellular behavior of periodontal ligament cells (PDLCs), thereby protecting the regenerative potential of bone tissue in an inflammatory state. However, the underlying mechanisms of the LIPUS therapy are still yet to be summarized. The goal of this review is to outline the potential cellular and molecular mechanisms of periodontitis-related LIPUS therapy, as well as to explain how LIPUS manages to transmit mechanical stimulation into the signaling pathway to achieve inflammatory control and periodontal bone regeneration.

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Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series

Cited by 9 publications

References 18 publications

A Retrospective Study: Is Low-Intensity Pulsed Ultrasound (LIPUS) an Effective Alternate Treatment Option for Non-union?

A Retrospective Study: Is Low-Intensity Pulsed Ultrasound (LIPUS) an Effective Alternate Treatment Option for Non-union?

Latest Progress of LIPUS in Fracture Healing

LIPUS as a potential strategy for periodontitis treatment: A review of the mechanisms

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