Low-intensity pulsed ultrasound(LIPUS) elicits faster bone healing after forearm osteotomy

Effect of low-intensity pulsed ultrasound on bone healing at osteotomy sites after forearm bone shortening   

Atsushi Urita, MD, PhD, Norimasa Iwasaki, MD, PhD, Makoto Kondo, Yasuhiko Nishio, MD, PhD, Tamotsu Kamishima, MD, PhD, Akio Minami, MD, PhD

Departments of Orthopaedic Surgery and Radiology, Hokkaido University School of Medicine; and the Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan

J Hand Surg Am. 2013 Mar;38(3):498-503. doi: 10.1016/j.jhsa.2012.11.032. Epub 2013 Feb 1

 

• Low intensity pulsed ultrasound has been used for the treatment of tibial non union. Randomized control trials have not been able to consistently prove that LIPUS is beneficial for fracture healing.
• In a study published in J Hand Surg Am. 2013, 27 patients required forearm osteotomy were randomized to receive LIPUS or not.  Patients were followed up to 24 weeks and outcomes were measured using the modified Mayo Wrist score.

• Population: 27 patients who underwent forearm osteotomy and fixation
• Intervention: LIPUS group received LIPUS at 1.5 MHz at intensity of 30 mW/cm sq. (14 patients).
• Comparison: 13 patients who did not receive LIPUS
• Outcomes:  Measured by x rays and clinical outcome by modified Mayo Wrist Score .
• Level of study: Level 2 therapeutic randomized control trial.
• Results: In the LIPUS group there was shorter duration towards endosteal healing compared to control. Clinical outcomes were similar in both groups.

• Conclusion: In this study with relatively small number of patients LIPUS was found to be beneficial. It is unclear whether this significantly shorter time to union can be extended to other fractures like tibial shaft, scaphoid etc. It has been postulated that LIPUS causes an increase in cell proliferation, protein synthesis, collagen synthesis, membrane permeability, increase cytosolic calcium, integrin expression which correlate with fracture repair. LIPUS is known to induce acoustic streaming and cavitation and there by imparting shear stress and strain to osteoblasts which may be beneficial for fracture healing.

 

Funding:Industry funded

Therapy: Level II – Randomized Trial

Sponsor:Teijin Pharma, Tokyo, Japan

Conflicts:None disclosed

 

Ref:

1. http://www.jhandsurg.org/article/S0363-5023%2812%2901722-4/abstract

2. http://www.myorthoevidence.com/?section=15&id=4792&list=72

3. http://www.ncbi.nlm.nih.gov/pubmed/23375786