Original contribution
Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound

https://doi.org/10.1016/j.ultrasmedbio.2003.11.008Get rights and content

Abstract

A clinical study was conducted to investigate the effect of low-intensity pulsed ultrasound (US) stimulation (LIPUS) on the healing of complex tibial fractures. Thirty complex tibial fractures were randomly assigned to the treatment with LIPUS (n = 16) or by a dummy machine (sham-exposed: n = 14). The fractures were immobilized by either internal or external fixations according to the clinical indications. LIPUS was given 20 min/day for 90 days. Fracture healing was monitored by clinical, radiological, densitometric and biochemical assessments. The LIPUS-treated group showed statistically significantly better healing, as demonstrated by all assessments. Complications were minimal in the LIPUS group. There were two cases of delayed union, with one in each group. There were two cases of infection in the control group. The delayed-union cases were subsequently treated by LIPUS and the infection cases were treated with standard protocol. Fracture healing in these patients was again treated by LIPUS. (E-mail: [email protected])

Section snippets

Introduction and literature

Low-intensity pulsed ultrasound (LIPUS) is a fracture-enhancement technique that has been shown to improve fracture healing in acute fractures (Busse et al., 2002, Cook et al., 1997, Duarte, 1983, Hadjiargyrou et al., 1998, Heckman et al., 1994, Kristiansen et al., 1997, Nolte et al., 2001, Pilla et al., 1990, Tsai et al., 1992, Xavier and Duarte, 1983). Most of the clinical studies focused on simple and closed fractures. There were, however, very few studies on fractures with potential

Patients recruitment

From September 1999 through April 2002, patients with open tibial fractures and high-energy-induced complex tibial fractures that included comminuted and segmental fractures were recruited in the study. The inclusion criteria were all comminution and open fractures at the tibial shaft, and the exclusion criteria were simple fractures or fractures at other sites. Written consent was obtained from all patients before the start of treatment. The study protocol was approved by the Clinical Research

Patient information

A total of 28 patients, 25 men and 3 women, with ages ranging from 22 to 61 years old (average 35.3 years) were recruited in this study. Of these, 4 patients had segmental fractures and, thus, a total of 30 fractures were studied. The fracture patterns are shown in Table 1.

The distribution of the LIPUS-treated and the control groups is shown in Table 2; 15 patients (16 fractures) were treated by LIPUS, and 13 (14 fractures) were treated with a dummy machine. The methods of surgical treatment

Discussion and summary

The results of this clinical study show that LIPUS enhances fracture healing in open fractures and high-energy-induced tibial fractures. The study was well controlled, in which the patients could not distinguish the difference between the US machines and the dummy machines. The clinical examination and the radiological assessment were also done by clinicians without knowing the application of US on the patients. The surgical treatment of the fractures was done according to the clinical

Acknowledgements

Low-intensity pulsed US machines were sponsored by Exogen, Smith & Nephew, Inc. This study was supported by the earmarked grant from the Hong Kong Research Grant Council (RGC reference no: CUHK 4257/99M).

References (26)

  • S.C. Findlay et al.

    Measurement of bone adjacent to tibial shaft fracture

    Osteoporos Int

    (2002)
  • M. Hadjiargyrou et al.

    Enhancement of fracture healing by low intensity ultrasound

    Clin Orthop

    (1998)
  • J.D. Heckman et al.

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

    J Bone Joint Surg

    (1994)
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