ISSN: 2577-297X
Authors: Jameel SS*, Harshavardhana NS, Shaw L and Srivastava S
Introduction: The incidence of non-union is 5% for all fractures. Non-operative biophysical modes to stimulate osteogenesis and fracture healing have explored electrical, laser and ultrasound modalities to varying degrees of success over the past few decades. Methods: This pilot study was undertaken at a District general hospital (DGH) in a publicly funded healthcare delivery system to assess the benefits and report the healing rate/success with use of Low intensity pulsed ultrasound (LIPUS) ExoGen device in delayed and non-unions of closed appendicular skeletal fractures. A standard device that delivered acoustic radiation at an operating frequency of 1.5 MHz with a temporal average power of 30 mW/cm2 and self-administered by the patient for 20mins/day for 250 sessions was used. Results: 11 adult patients enrolled into the study were followed-up until the end of their treatment and seven of them had clinical plus radiological union with excellent outcomes. The mean age of patients was 54.9years (range: 26 to 71y). The mean follow-up duration was 18.5months (range: 10.0 to 24.5m). The mean duration from sustaining the fracture to application of ExoGen to hasten osteosynthesis was 4.1months (range: 1.0 to 9.0m). Two patients warranted revision surgery to achieve fracture union. Of the remaining two patients, one with fibrous non-union was coping satisfactorily whilst a salvage procedure was proposed for another. Discussion: LIPUS was used as an ‘Alternative’ to surgery (and revision surgery) in all but one patient where it was used as an adjunct with surgery. There were no complications with its use and the healing rate was 63.6% (7/11 patients). There was an estimated cost savings of at least £10,000 in this small cohort of patients. Smoking status, high velocity trauma, advancing age or gender did not influence the outcomes.
Keywords: Orthopaedic Trauma; Bone Morphogenetic Protein; Osteosynthesis; Low Intensity Pulsed Ultrasound
