The effect of whole body vibration on fracture healing – a systematic review

Abstract

This systematic review examines the efficacy and safety of whole body vibration (WBV) on fracture healing. A systematic literature search was conducted with relevant keywords in PubMed and Embase, independently, by two reviewers. Original animal and clinical studies about WBV effects on fracture healing with available full-text and written in English were included. Information was extracted from the included studies for review. In total, 19 articles about pre-clinical studies were selected. Various vibration regimes are reported; of those, the frequencies of 35 Hz and 50 Hz show better results than others. Most of the studies show positive effects on fracture healing after vibration treatment and the responses to vibration are better in ovariectomised (OVX) animals than non-OVX ones. However, several studies provide insufficient evidence to support an improvement of fracture healing after vibration and one study even reports disruption of fracture healing after vibration. In three studies, vibration results in positive effects on angiogenesis at the fracture site and surrounding muscles during fracture healing. No serious complications or side effects of vibration are found in these studies. WBV is suggested to be beneficial in improving fracture healing in animals without safety problem reported. In order to apply vibration on fractured patients, more well-designed randomised controlled clinical trials are needed to examine its efficacy, regimes and safety. Keywords THE EFFECT OF WHOLE BODY VIBRATION ON FRACTURE HEALING -A SYSTEMATIC REVIEW IntroductionFracture is a common musculoskeletal problem with high morbidity. Most fractures usually heal uneventfully well, but about 5-10 % of the fractures result in impaired healing, such as delayed union and non-union (Rozen et al., 2007). Therefore, it is of great importance to develop more efficient management to minimise delayed union and nonunion. Fracture healing is a complicated biological process that consists of an inflammatory stage, repair stage and remodelling stage (Kalfas, 2001). The healing process can be influenced by various factors, of which biomechanical condition at the fracture site is considered as one of the key determinants (Einhorn, 1998;Hannouche et al., 2001 et al., 2014). Some studies provide evidence that WBV has effects on the musculoskeletal system, including improving muscle function (Rees et al., 2008;Sitja-Rabert et al., 2015), increasing bone mineral density (BMD) (Lam et al., 2013;Verschueren et al., 2004), reducing risks of falls and improving muscle strength and balancing ability . Low-magnitude high-frequency vibration (LMHFV), a type of WBV with magnitude usually lower than 1 ×g [magnitude, in gravitational acceleration (m/s2 )] and frequency ranged from 20 to 90 Hz (Bemben et al., 2010;Fuermaier et al., 2014;von Stengel et al., 2011), is also reported to have positive effects on osteogenic differentiation and osteogenesis (Dumas et al., 2010;Kim et al., 2012;Leung et al., 2014;Luu et al., 2009). Some previous studies usi...

Vibration acceleration promotes endochondral formation during fracture healing through cellular chondrogenic differentiation

“…Taken together, the promotive effect on fracture healing may be dependent on the condition of WBV, and for Power Plate 1 , the amplitude setting may be important. With regard to other devices of WBV, a systematic review on their effects on fracture healing has recently been published and has presented controversial results among in vivo studies [51]. These differences Col-II on days 10 and 14, and ACN on day 14 in the ATDC5 cell line and SOX-9 on day 7, Col-II on days 7 and 10, and ACN on day 14 in the C3H10T1/2 cell line were significantly higher in the V-group than those in the C-group.…”

Analysis of low-dose estrogen on callus BMD as measured by pQCT in postmenopausal women

“…It is noteworthy that mechanostimulation by low-magnitude high frequency vibration was shown to provoke anabolic effects on the intact skeleton of both mice and human. This effect is estrogen-dependent and shown to be mediated primarily via the estrogen receptor alpha in mice, and vibration-induced effects on fracture healing in combination with estrogen treatment have also been shown to improve the osteopenic bone structure and increased the bone stiffness in preclinical studies [14,[39][40][41]. Thus, it is possible that such a combination of treatments rather than estrogen treatment alone could improve the healing of bone fractures by positively affecting callus BMD as measured by pQCT.…”

Impaired Fracture Healing in Sarco‐Osteoporotic Mice Can Be Rescued by Vibration Treatment Through Myostatin Suppression

“…Meanwhile, during osteoporotic fracture, there is a lack of evidence on how sarcopenia affects bone healing. Interestingly, our previous studies demonstrated that osteoporotic fractured bone was very sensitive to mechanical signals in the form of vibration, as compared with age‐matched non‐osteoporotic bone, which is contradictory to general belief. Estrogen receptor (ER) is therefore proposed to play a critical role, as ER is also a signaling molecule in mechanotransduction.…”