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Biological effects of extracorporeal shockwave in bone healing: a study in rabbits

  • Ching-Jen Wang
  • Feng-Sheng Wang
  • Kuender D. Yang
Basic Science

Abstract

Introduction

This study is an investigation of the biological effects of extracorporeal shockwave treatment (ESWT) on bone healing in a rabbit model.

Materials and methods

Sixteen 12-month-old New Zealand white rabbits with body weight ranging from 2.5 to 3.5 kg were used in the study. An intra-medullary pin was inserted retrograde into the femur canal. A closed fracture of the femur was created with a three-point bend method. The animals were randomly divided into the study group and the control group with eight rabbits in each group. The study group received shockwave treatment, whereas the control group did not. The animals were killed at 12 weeks, and a 5-cm long femur bone including the callus was harvested. The specimens were subjected to biomechanical study, histomorphological examination, and immunohistochemical analysis.

Results

The shockwave group showed significantly better bone strength in biomechanical study, more cortical bone formation in histomorphological examination and higher number of neo-vessels and angiogenic and osteogenic growth markers including VEGF, eNOS, PCNA, and BMP-2 on immunohistochemical stains than the control group.

Conclusion

ESWT significantly improved bone healing after fracture of the femur in rabbit. ESWT promoted the formation of cortical bone what might have been associated with increased biomechanical results. ESWT-promoted bone healing was associated with increased neovascularization and up-regulation of angiogenic and osteogenic growth factors.

Keywords

Shockwave Bone healing Biological effect Rabbits 

Notes

Acknowledgments

Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were National Health Research Institute (NHRI-EX96-9423EP) and Chang Gung Research Fund (CMRPG8049). The authors thank Ms Yi-Chih Sun, Ya-Ju Yang and Ya-Hsueh Chuang for their technical assistance in animal experiments and data collection in this study. No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.

References

  1. 1.
    Chen YJ, Kuo YR, Yang KD, Wang CJ, Huang HC, Wang FS (2003) Shock wave application enhances pertussis toxin-sensitive bone formation in segmental defect in rats. J Bone Miner Res 18:2169–2179PubMedCrossRefGoogle Scholar
  2. 2.
    Delius M, Draenert K, Al Diek Y, Draenert Y (1995) Biological effect of shockwave: in vivo effect of high-energy pulses on rabbit bone. Ultrasound Med Biol 21:1219–1225PubMedCrossRefGoogle Scholar
  3. 3.
    Haupt G (1997) Use of extracorporeal shock wave in the treatment of pseudoarthrosis, tendinopathy and other orthopaedic disease. J Urol 158:4–11PubMedCrossRefGoogle Scholar
  4. 4.
    Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M (1992) Influence of shockwave on fracture healing. Urology 39:529–532PubMedCrossRefGoogle Scholar
  5. 5.
    Jamsa T, Jalovaara P, Peng Z, Vaananen HK, Tuukkanen J (1998) Comparison of three-point bending test and peripheral quantitative computed tomography analysis in the evaluation of the strength in mouse femur and tibia. Bone 23:155–161PubMedCrossRefGoogle Scholar
  6. 6.
    Johannes EJ, Kaulesar Sukul DM, Matura E (1994) High-energy shockwave for treatment of nonunion. An experiment on dogs. J Surg Res 57:246–252PubMedCrossRefGoogle Scholar
  7. 7.
    Kaulesar Sukul DM, Johannes EJ, Pierik EG, van Eijck GJ, Kristelijn MJ (1993) The effect of high-energy shock waves focused on cortical bone: an in vitro study. J Surg Res 54:46–51PubMedCrossRefGoogle Scholar
  8. 8.
    Ogden JA, Tóth-Kischkat A, Schultheiss R (2001) Principles of shock wave therapy. Clin Orthop 387:8–17PubMedCrossRefGoogle Scholar
  9. 9.
    Rompe JD, Rosendahl T, Schöllner C, Theis C (2001) High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop 387:102–111PubMedCrossRefGoogle Scholar
  10. 10.
    Schaden W, Fischer A, Sailer A (2001) Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop 387:90–94PubMedCrossRefGoogle Scholar
  11. 11.
    Schleberger R, Senge T (1992) Noninvasive treatment of long bone pseudoarthrosis by shock waves (ESWL). Arch Ortho Trauma Surg 111:224–227CrossRefGoogle Scholar
  12. 12.
    Valchanou VD, Michailov P (1991) High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 15:181–184PubMedCrossRefGoogle Scholar
  13. 13.
    Vogel J, Hopf C, Eysel P, Rompe JD (1997) Application of extracorporeal shock waves in the treatment of pseudarthrosis of the lower extremity: preliminary results. Arch Orthop Trauma Surg 116:480–483PubMedCrossRefGoogle Scholar
  14. 14.
    Wang CJ, Chen HS, Chen CE, Yang KD (2001) Treatment of nonunions of long bone fractures with shock waves. Clin Orthop 387:95–101PubMedCrossRefGoogle Scholar
  15. 15.
    Wang CJ, Huang HY, Chen HH, Pai CH, Yang KD (2001) The effect of shock wave therapy on acute fractures of the tibia. A study in a dog model. Clin Orthop 387:112–118PubMedCrossRefGoogle Scholar
  16. 16.
    Wang FS, Wang CJ, Huang HC, Chung H, Chen RF, Yang KD (2001) Physical shock wave mediates membrane hyperpolarization and Ras activation for osteogenesis in human bone marrow stromal cells. Biochem Biophys Res Commun 287:648–655PubMedCrossRefGoogle Scholar
  17. 17.
    Wang CJ, Huang HY, Pai CH (2002) Shock wave enhanced neovascularization at the bone-tendon junction. A study in a dog model. J Foot Ankle Surg 41:16–22PubMedCrossRefGoogle Scholar
  18. 18.
    Wang FS, Wang CJ, Sheen-Chen SM, Chen RF, Kuo YR, Yang KD (2002) Superoxide mediates shock wave induction of ERK-dependent osteogenic transcription factor (CBFA1) and mesenchymal cells differentiation toward osteoprogenitors. J Biol Chem 277:10931–10937PubMedCrossRefGoogle Scholar
  19. 19.
    Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM (2002) Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1. J Bone Joint Surg 84B:457–461CrossRefGoogle Scholar
  20. 20.
    Wang CJ, Wang FS, Yang KD, Huang CS, Hsu CC (2003) Shockwave therapy induced neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 21:984–989PubMedCrossRefGoogle Scholar
  21. 21.
    Wang FS, Yang KD, Kuo YR, Wang CJ, Huang HJ, Chen YJ (2003) Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wave-promoted healing of fracture defect. Bone 32:387–396PubMedCrossRefGoogle Scholar
  22. 22.
    Wang CJ, Wang FS, Yang KD (2004) Shock wave treatment produced dose-dependent enhancement in bone mass and bone strength after fracture. Bone 34:225–230PubMedCrossRefGoogle Scholar
  23. 23.
    Yang C, Heston WDW, Gulati S, Fair WR (1988) The effects of high-energy shock waves (HESW) on human bone marrow. Urol Res 16:427–429PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ching-Jen Wang
    • 1
  • Feng-Sheng Wang
    • 2
  • Kuender D. Yang
    • 2
  1. 1.Department of Orthopedic SurgeryChang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Department of Medical ResearchChang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiungTaiwan

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