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Searle HKC, Lewis SR, Coyle C, Welch M, Griffin XL. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev 2023; 3:CD008579. [PMID: 36866917 PMCID: PMC9983300 DOI: 10.1002/14651858.cd008579.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The morbidity and socioeconomic costs of fractures are considerable. The length of time to healing is an important factor in determining a person's recovery after a fracture. Ultrasound may have a therapeutic role in reducing the time to union after fracture by stimulating osteoblasts and other bone-forming proteins. This is an update of a review previously published in February 2014. OBJECTIVES: To assess the effects of low-intensity ultrasound (LIPUS), high-intensity focused ultrasound (HIFUS) and extracorporeal shockwave therapies (ECSW) as part of the treatment of acute fractures in adults. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase (1980 to March 2022), Orthopaedic Proceedings, trial registers and reference lists of articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs including participants over 18 years of age with acute fractures (complete or stress fractures) treated with either LIPUS, HIFUS or ECSW versus a control or placebo-control. DATA COLLECTION AND ANALYSIS We used standard methodology expected by Cochrane. We collected data for the following critical outcomes: participant-reported quality of life, quantitative functional improvement, time to return to normal activities, time to fracture union, pain, delayed or non-union of fracture. We also collected data for treatment-related adverse events. We collected data in the short term (up to three months after surgery) and in the medium term (later than three months after surgery). MAIN RESULTS: We included 21 studies, involving 1543 fractures in 1517 participants; two studies were quasi-RCTs. Twenty studies tested LIPUS and one trial tested ECSW; no studies tested HIFUS. Four studies did not report any of the critical outcomes. All studies had unclear or high risk of bias in at least one domain. The certainty of the evidence was downgraded for imprecision, risk of bias and inconsistency. LIPUS versus control (20 studies, 1459 participants) We found very low-certainty evidence for the effect of LIPUS on Health-related quality of life (HRQoL) measured by SF-36 at up to one year after surgery for lower limb fractures (mean difference (MD) 0.06, 95% confidence interval (CI) -3.85 to 3.97, favours LIPUS; 3 studies, 393 participants). This result was compatible with a clinically important difference of 3 units with both LIPUS or control. There may be little to no difference in time to return to work after people had complete fractures of the upper or lower limbs (MD 1.96 days, 95% CI -2.13 to 6.04, favours control; 2 studies, 370 participants; low-certainty evidence). There is probably little or no difference in delayed union or non-union up to 12 months after surgery (RR 1.25, 95% CI 0.50 to 3.09, favours control; 7 studies, 746 participants; moderate-certainty evidence). Although data for delayed and non-union included both upper and lower limbs, we noted that there were no incidences of delayed or non-union in upper limb fractures. We did not pool data for time to fracture union (11 studies, 887 participants; very low-certainty evidence) because of substantial statistical heterogeneity which we could not explain. In upper limb fractures, MDs ranged from 0.32 to 40 fewer days to fracture union with LIPUS. In lower limb fractures, MDs ranged from 88 fewer days to 30 more days to fracture union. We also did not pool data for pain experienced at one month after surgery in people with upper limb fractures (2 studies, 148 participants; very low-certainty evidence) because of substantial unexplained statistical heterogeneity. Using a 10-point visual analogue scale, one study reported less pain with LIPUS (MD -1.7, 95% CI -3.03 to -0.37; 47 participants), and the effect was less precise in the other study (MD -0.4, 95% CI -0.61 to 0.53; 101 participants). We found little or no difference in skin irritation (a possible treatment-related adverse event) between groups but judged the certainty of the evidence from this small study to be very low (RR 0.94, 95% CI 0.06 to 14.65; 1 study, 101 participants). No studies reported data for functional recovery. Data for treatment adherence were inconsistently reported across studies, but was generally described to be good. Data for costs were reported for one study, with higher direct costs, as well as combined direct and indirect costs, for LIPUS use. ECSW versus control (1 study, 56 participants) We are uncertain whether ECSW reduces pain at 12 months after surgery in fractures of the lower limb (MD -0.62, 95% CI -0.97 to -0.27, favours ECSW); the difference between pain scores was unlikely to be clinically important, and the certainty of the evidence was very low. We are also uncertain of the effect of ECSW on delayed or non-union at 12 months because the certainty of this evidence is very low (RR 0.56, 95% CI 0.15 to 2.01; 1 study, 57 participants). There were no treatment-related adverse events. This study reported no data for HRQoL, functional recovery, time to return to normal activities, or time to fracture union. In addition, no data were available for adherence or cost. AUTHORS' CONCLUSIONS We were uncertain of the effectiveness of ultrasound and shock wave therapy for acute fractures in terms of patient-reported outcome measures (PROMS), for which few studies reported data. It is probable that LIPUS makes little or no difference to delayed union or non-union. Future trials should be double-blind, randomised, placebo-controlled trials recording validated PROMs and following up all trial participants. Whilst time to union is difficult to measure, the proportion of participants achieving clinical and radiographic union at each follow-up point should be ascertained, alongside adherence with the study protocol and cost of treatment in order to better inform clinical practice.
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Affiliation(s)
- Henry KC Searle
- Oxford University Clinical Academic Graduate School, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
- John Radcliffe Hospital, Oxford, UK
| | - Sharon R Lewis
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Matthew Welch
- Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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Alshihah N, Alhadlaq A, El-Bialy T, Aldahmash A, Bello IO. The effect of low intensity pulsed ultrasound on dentoalveolar structures during orthodontic force application in diabetic ex-vivo model. Arch Oral Biol 2020; 119:104883. [PMID: 32932147 DOI: 10.1016/j.archoralbio.2020.104883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of the low intensity pulsed ultrasound (LIPUS) on the dentoalveolar structures during orthodontic force application in ex-vivo model using mandible slice organ culture (MSOC) of diabetic rats. DESIGN 18 male Wistar rats with a mean weight (275 g) were randomly divided into three main groups: 1) normal rats, 2) Insulin treated diabetic rats, and 3) diabetic rats. Diabetes mellitus (DM) was induced by streptozotocin. Four weeks later, rats were euthanized, mandibles were dissected, divided into 1.5-mm slices creating mandible slice organ cultures (MSOCs). MSOCs were cultured at 37 °C in air with 5 % CO2. The following day, orthodontic spring delivering a 50-g of force was applied to each slice. In each group, rats were randomly assigned to 2 subgroups; one received 10 min of LIPUS daily and the other was the control. Culture continued for 7 days, and then the sections were prepared for histological and histomorphometric analysis. RESULTS For all study groups (Normal, Insulin Treated Diabetic and Diabetic), LIPUS treatment significantly increased the thickness of predentin, cementum, and improved bone remodeling on the tension side and increased odontoblast, sub-odontoblast, and periodontal ligaments cell counts and bone resorption lacunae number on the compression side. CONCLUSIONS Application of LIPUS treatment for 10 min daily for a week enhanced bone remodeling and repair of cementum and dentin in normal as well as diabetic MSOCs.
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Affiliation(s)
- Nada Alshihah
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Adel Alhadlaq
- Division of Orthodontics, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | - Tarek El-Bialy
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Abdullah Aldahmash
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ibrahim Olajide Bello
- Department of Oral Medicine and Diagnostic Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Gopalan A, Panneerselvam E, Doss GT, Ponvel K, Raja VB K. Evaluation of Efficacy of Low Intensity Pulsed Ultrasound in Facilitating Mandibular Fracture Healing—A Blinded Randomized Controlled Clinical Trial. J Oral Maxillofac Surg 2020; 78:997.e1-997.e7. [DOI: 10.1016/j.joms.2020.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 01/15/2023]
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Wu S, Xu X, Sun J, Zhang Y, Shi J, Xu T. Low-Intensity Pulsed Ultrasound Accelerates Traumatic Vertebral Fracture Healing by Coupling Proliferation of Type H Microvessels. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1733-1742. [PMID: 29363151 DOI: 10.1002/jum.14525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/04/2017] [Accepted: 10/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Patients with traumatic vertebral fractures often have major associated postoperative morbidities such as healing failure and kyphosis. Low-intensity pulsed ultrasound (US) has been found to promote bone fracture healing. The objectives of our study were to determine whether low-intensity pulsed US could promote traumatic vertebral fracture healing and to explore its inner mechanisms. METHODS A rat model of traumatic vertebral fracture was created and treated with low-intensity pulsed US after surgery. At 4 weeks after surgery, radiographic, micro-computed tomography, and 3-dimensional reconstruction were used to assess the radiologic healing status; a histologic analysis was performed to evaluate the pathologic process and relationship between osteogenesis and type H microvessels. RESULTS Well-remodeled trabecular meshworks were found in the low-intensity pulsed US treatment group compared to the control group. Micro-computed tomography and 3-dimensional reconstruction revealed more and thicker trabeculae after low-intensity pulsed US treatment. Abundant chondrocytes, a newly formed bone marrow cavity, trabeculae, and microvessels were formed at the fracture sites. More osterix-positive osteoblasts were circling the newly formed bone meshwork and were situated at the interface of chondrocytes in the low-intensity pulsed US treatment group. Type H microvessels were spreading around the newly formed trabecula, bone marrow cavity, osteoblasts, and interface of chondrocytes, with a larger mean vascular density in the low-intensity pulsed US group. CONCLUSIONS Low-intensity pulsed US could accelerate traumatic vertebral fracture healing by temporally and spatially increasing chondrogenesis and osteoblast-induced osteogenesis coupled with angiogenesis of type H microvessels in a rat model of traumatic vertebral fracture.
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Affiliation(s)
- Suiyi Wu
- Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Ximing Xu
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingchuan Sun
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yao Zhang
- Cadet Brigade, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tianming Xu
- 455 Hospital of Chinese People's Liberation Army, Shanghai, China
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Rutten S, van den Bekerom MPJ, Sierevelt IN, Nolte PA. Enhancement of Bone-Healing by Low-Intensity Pulsed Ultrasound: A Systematic Review. JBJS Rev 2018; 4:01874474-201603000-00006. [PMID: 27500435 DOI: 10.2106/jbjs.rvw.o.00027] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low-intensity pulsed ultrasound (LIPUS) is frequently used to enhance or to accelerate fracture-healing, but its clinical role and effectiveness as a treatment modality remain uncertain. We performed a systematic review and meta-analysis of randomized controlled trials to determine the efficiency of LIPUS on bone-healing and/or fracture union, as well as on functional recovery. METHODS The databases of PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and Embase were searched for trials concerning LIPUS stimulation and bone-healing or fracture repair, in any language, published from the inception of the database to January 2, 2015. Eligible studies were randomized controlled trials that enrolled patients with any type of fracture, delayed union, or nonunion and randomly assigned them to LIPUS treatment or a control group. Two reviewers independently agreed on eligibility, assessed methodological quality, and extracted outcome data. All relevant outcomes were pooled, and a meta-analysis was performed. RESULTS Twenty-four unique randomized trials were selected for analysis after the search of all databases and the inclusion of one trial by the senior author. Time to radiographic fracture union was the most common primary outcome measure evaluated. After pooling the data concerning time to radiographic healing in the combined patient population (n = 429), LIPUS treatment resulted in a mean reduction in healing time of 39.8 days (95% confidence interval, 17.7 to 62.0 days; I = 94%). The most reduction in time to radiographic union by LIPUS treatment was seen in fractures with a long natural healing tendency. Three trials evaluating the time to return to work or active duty, as a surrogate for functional recovery, were unable to demonstrate a beneficial effect of LIPUS (n = 179). Evidence from two high-quality trials implied that LIPUS enhances fracture-healing through increased bone formation in cases of delayed and/or impaired bone-healing. The prevention of delayed union or nonunion by LIPUS treatment could not be demonstrated. CONCLUSIONS LIPUS treatment effectively reduces the time to radiographic fracture union, but this does not directly result in a beneficial effect of accelerated functional recovery or the prevention of delayed union or nonunion. The increase in bone formation as a result of LIPUS treatment may provide a valuable tool in fracture repair, but it does not always lead to healing. Future studies should focus on reporting of a combination of subjective signs of clinical healing, functional recovery, and radiographic union to determine the effectiveness of LIPUS treatment in clinical fracture-healing. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sjoerd Rutten
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, the Netherlands
| | | | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, the Netherlands
| | - Petrus A Nolte
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, the Netherlands
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Bayat M, Virdi A, Jalalifirouzkouhi R, Rezaei F. Comparison of effects of LLLT and LIPUS on fracture healing in animal models and patients: A systematic review. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2018; 132:3-22. [PMID: 28688752 DOI: 10.1016/j.pbiomolbio.2017.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 12/29/2022]
Abstract
The aim of this paper is to study the in vivo potency of low-level laser therapy (LLLT) and low intensity pulsed ultrasound (LIPUS) alone, accompanied by bone grafts, or accompanied by other factors on fracture healing in animal models and patients. In this paper, we aim to systematically review the published scientific literature regarding the use of LLLT and LIPUS to accelerate fracture healing in animal models and patients. We searched the PubMed database for the terms LLLT or LIPUS and/or bone, and fracture. Our analysis also suggests that both LIPUS and LLLT may be beneficial to fracture healing in patients, and that LIPUS is more effective. These finding are of considerable importance in those treatments with a LIPUS, as a laser device may reduce healing time. The most clinically relevant impact of the LIPUS treatment could be a significant reduction in the proportion of patients who go on to develop a nonunion. If it is confirmed that the therapeutic influence is true and reliable, patients will obtain benefits from LIPUS and LLLT. Further clinical trials of high methodological quality are needed in order to determine the optimal role of LIPUS and LLLT in fracture healing in patients.
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Affiliation(s)
- Mohammad Bayat
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, USA; Cellular and Molecular Biology Research Center, Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Amarjit Virdi
- Department of Cell & Molecular Medicine, (formerly, Anatomy and Cell Biology), Rush University Medical Center, 1750 W. Harrison St., Suite 1413A, Chicago, IL 60612, USA.
| | | | - Fatemehalsadat Rezaei
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
BACKGROUND Low-intensity pulsed ultrasonography (LIPUS) is a form of mechanical stimulation that is delivered via a special device to the fracture site for the acceleration of fracture healing. We conducted a meta-analysis to assess the effect of LIPUS for fresh fractures in adults. METHODS MEDLINE, EMBASE and the Cochrane Library searched between Jan 1980 and Nov 2016. Studies should be quasi-randomized and randomized controlled trials (RCTs) comparing treatment with LIPUS to placebo or no treatment in adults with fresh fractures, reporting outcomes such as function; time to union; delayed union or non-union. Summary standard mean difference (SMD) and the risk ratio (RR) with their 95% confidence interval (CI) calculated with a random effects model. I statistic was used to assess the heterogeneity. Risk of bias was assessed by the Cochrane risk-of-bias tool. The GRADE system was used to evaluate the evidence quality. RESULTS A total of 12 trials with 1099 patients were included. The pooled results showed that LIPUS significantly reduced the time to fracture union (SMD: 0.65, 95% CI: 1.13 to 0.17), improved the quality of life (SMD: 0.20, 95% CI: 0.03-0.37) without affecting the time to full weight bearing (SMD: 0.76, 95% CI: 1.92 to 0.4), the time to return to work (SMD: 0.06, 95% CI: 0.14 to 0.27), or the incidence rate of delayed union and nonunion (RR: 1.02, 95% CI: 0.60-1.74). CONCLUSIONS Moderate-to-high quality evidence shows that LIPUS treatment reduces the time to fracture union and improves the quality of life without affecting functional recovery and incident rate of delayed union and nonunion, suggesting that LIPUS treatment may be a good treatment modality for adults with fresh fractures. However, there are some methodological limitations in the eligible trials, further studies are needed to determine the clinical circumstances under which LIPUS is truly valid and to examine the optimal approach for the use of this adjunctive therapy.
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Affiliation(s)
- Shenghan Lou
- Department of Orthopedics, Chinese PLA General Hospital, Beijing
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Houchen Lv
- Department of Orthopedics, Chinese PLA General Hospital, Beijing
| | - Zhirui Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing
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Ota T, Itoh S, Yamashita K. The efficacy and safety of combination therapy of low-intensity pulsed ultrasound stimulation in the treatment of unstable both radius and ulna fractures in children. Biomed Mater Eng 2017; 28:545-553. [PMID: 28854496 DOI: 10.3233/bme-171697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are few reports of Low-intensity pulsed ultrasound (LIPUS) treatment for fresh forearm fractures in children. OBJECTIVES LIPUS stimulation was applied after surgery of forearm fractures in children and the efficacy and safety of combination therapy of LIPUS treatment were evaluated. PATIENTS AND METHODS Children with both radius and ulna fracture, twenty-five diaphysis (mid-R&U) and nineteen metaphysis (dist-R&U) fractures, were treated with intramedullary nailing followed by cast and splint mobilization. Thirteen patients in the mid-R&U fracture group and eight patients in the dist-R&U fracture group were combined with LIPUS stimulation postoperatively. RESULTS Periosteal callus appeared significantly earlier after surgery in the LIPUS-treated groups than in the groups without LIPUS treatment. The duration of external fixation was significantly shorter in the dist-R&U fracture group treated with LIPUS stimulation compared with that in the mid-R&U fracture group without LIPUS treatment. Furthermore, the time span needed for bone union in the groups with LIPUS stimulation was significantly shorter than in the groups without LIPUS stimulation. CONCLUSIONS It is suggested that LIPUS stimulation can lead to a reduction of treatment periods of unstable forearm fractures safely after operation even in children.
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Affiliation(s)
- Tsuyoshi Ota
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi City, Saitama 332-8558, Japan. E-mail:
| | - Soichiro Itoh
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan. E-mail:
| | - Kimihiro Yamashita
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan. E-mail:
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Schandelmaier S, Kaushal A, Lytvyn L, Heels-Ansdell D, Siemieniuk RAC, Agoritsas T, Guyatt GH, Vandvik PO, Couban R, Mollon B, Busse JW. Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials. BMJ 2017; 356:j656. [PMID: 28348110 PMCID: PMC5484179 DOI: 10.1136/bmj.j656] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
Abstract
Objective To determine the efficacy of low intensity pulsed ultrasound (LIPUS) for healing of fracture or osteotomy.Design Systematic review and meta-analysis.Data sources Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and trial registries up to November 2016.Study selection Randomized controlled trials of LIPUS compared with sham device or no device in patients with any kind of fracture or osteotomy.Review methods Two independent reviewers identified studies, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including selection of outcomes important to patients. The GRADE system was used to assess the quality of evidence.Results 26 randomized controlled trials with a median sample size of 30 (range 8-501) were included. The most trustworthy evidence came from four trials at low risk of bias that included patients with tibia or clavicle fractures. Compared with control, LIPUS did not reduce time to return to work (percentage difference: 2.7% later with LIPUS, 95% confidence interval 7.7% earlier to 14.3% later; moderate certainty) or the number of subsequent operations (risk ratio 0.80, 95% confidence interval 0.55 to 1.16; moderate certainty). For pain, days to weight bearing, and radiographic healing, effects varied substantially among studies. For all three outcomes, trials at low risk of bias failed to show a benefit with LIPUS, while trials at high risk of bias suggested a benefit (interaction P<0.001). When only trials at low risk of bias trials were considered, LIPUS did not reduce days to weight bearing (4.8% later, 4.0% earlier to 14.4% later; high certainty), pain at four to six weeks (mean difference on 0-100 visual analogue scale: 0.93 lower, 2.51 lower to 0.64 higher; high certainty), and days to radiographic healing (1.7% earlier, 11.2% earlier to 8.8% later; moderate certainty).Conclusions Based on moderate to high quality evidence from studies in patients with fresh fracture, LIPUS does not improve outcomes important to patients and probably has no effect on radiographic bone healing. The applicability to other types of fracture or osteotomy is open to debate.Systematic review registration PROSPERO CRD42016050965.
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Affiliation(s)
- Stefan Schandelmaier
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland
| | - Alka Kaushal
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Lyubov Lytvyn
- Oslo University Hospital, Forskningsveien 2b, Postboks 1089, Blindern 0317 Oslo, Norway
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Reed A C Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Division General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Brent Mollon
- Orillia Soldiers' Memorial Hospital, 41 Frederick Street, Orillia, ON L3V 5W6, Canada
| | - Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON L8S 4K1, Canada
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Haffner-Luntzer M, Liedert A, Ignatius A. Mechanobiology of bone remodeling and fracture healing in the aged organism. Innov Surg Sci 2016; 1:57-63. [PMID: 31579720 PMCID: PMC6753991 DOI: 10.1515/iss-2016-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/14/2016] [Indexed: 01/18/2023] Open
Abstract
Bone can adapt to changing load demands by mechanically regulated bone remodeling. Osteocytes, osteoblasts, and mesenchymal stem cells are mechanosensitive and respond to mechanical signals through the activation of specific molecular signaling pathways. The process of bone regeneration after fracture is similarly and highly regulated by the biomechanical environment at the fracture site. Depending on the tissue strains, mesenchymal cells differentiate into fibroblasts, chondrocytes, or osteoblasts, determining the course and the success of healing. In the aged organism, mechanotransduction in both intact and fractured bones may be altered due to changed hormone levels and expression of growth factors and other signaling molecules. It is proposed that altered mechanotransduction may contribute to disturbed healing in aged patients. This review explains the basic principles of mechanotransduction in the bone and the fracture callus and summarizes the current knowledge on aging-induced changes in mechanobiology. Furthermore, the methods for external biomechanical stimulation of intact and fractured bones are discussed with respect to a possible application in the elderly patient.
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Affiliation(s)
- Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Astrid Liedert
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Helmholtzstraße 14, 89081 Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Helmholtzstraße 14, 89081 Ulm, Germany
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Foulke BA, Kendal AR, Murray DW, Pandit H. Fracture healing in the elderly: A review. Maturitas 2016; 92:49-55. [PMID: 27621238 DOI: 10.1016/j.maturitas.2016.07.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 01/08/2023]
Abstract
Older patients are commonly at a higher risk of experiencing a bone fracture. Complications during fracture healing, including delayed union and non-union, can arise as a result of a multitude of patient and treatment factors. This review describes those factors which contribute to a greater risk of delayed union and non-union with particular reference to the elderly population and discusses therapies that may enhance the fracture healing process in the hope of reducing the incidence of delayed union and non-union. Increasing age does seem to increase the risk of delayed union or non-union. In addition, smoking and the treatment of post-fracture pain with non-steroidal anti-inflammatory drugs (NSAIDs) put the patient at the greatest risk, while ultrasound therapy appears to be a non-invasive, effective treatment option to reduce the risk of delayed union or non-union. The use of growth factors and of stem cells and the role of surgery are also discussed.
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Affiliation(s)
- Bradley A Foulke
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - Adrian R Kendal
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Multiple Integrated Complementary Healing Approaches: Energetics & Light for bone. Med Hypotheses 2016; 86:18-29. [DOI: 10.1016/j.mehy.2015.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/30/2015] [Indexed: 02/08/2023]
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Durgun M, Dasdag S, Erbatur S, Yegin K, Durgun SO, Uzun C, Ogucu G, Alabalik U, Akdag MZ. Effect of 2100 MHz mobile phone radiation on healing of mandibular fractures: an experimental study in rabbits. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1102612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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