Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures

Abstract

Background

Postoperative delayed union and nonunion is the most common complication in fracture treatment. Recent studies have shown an accelerating effect of low-intensity pulsed ultrasound (LIPUS) on fracture repair. However, the indications for delayed union and nonunion are not clear. To clarify the factors which influence the effects of LIPUS, the data from a previous prospective multicenter study on LIPUS treatment for postoperative delayed union and nonunion of long bone fractures were reanalyzed.

Methods

Seventy-two cases of long bone fracture, including those of the femur, tibia, humerus, radius, and ulna, were analyzed. The mean time from the most recent operation to the beginning of LIPUS treatment was 11.5 (3–68) months. The relationship between the background factors and the union rate was analyzed using a logistic regression method. In addition, long bone fractures in an upper extremity or in a lower extremity were analyzed separately.

Results

The union rate was 75% in all the cases of long bone fracture. There was a significant relationship between the union rate and the period from the most recent operation to the beginning of LIPUS treatment in all cases and in those that had long bone fracture of an upper extremity. There was also a significant relationship between the union rate and the time when a radiological improvement was first observed after the beginning of the treatment in all cases and in those with fractures in a lower extremity. When LIPUS treatment was started within 6 months of the most recent operation, 89.7% of all fractures healed. When an improvement in the radiological changes at the fracture site was observed after 4 months in those cases, then the sensitivity and specificity for union were more than 90%.

Conclusions

LIPUS treatment should be started within 6 months of the most recent operation. Because LIPUS has been shown to be effective without causing either serious invasiveness or any undue risk to the patient, it may be considered the treatment of first choice for cases of postoperative delayed union or nonunion.

This is a preview of subscription content, access via your institution.

References

  1. 1

    JD Heckman JP Ryaby J McCabe JJ Frey RF Kilcoyne (1994) ArticleTitleAcceleration of tibial fracture-healing by noninvasive, low-intensity pulsed ultrasound J Bone Joint Surg Am 76 26–34 Occurrence Handle1:STN:280:DyaK2c7hslGhug%3D%3D Occurrence Handle8288661

    CAS  PubMed  Google Scholar 

  2. 2

    TK Kristiansen JP Ryaby J McCabe JJ Frey LA Roe (1997) ArticleTitleAccelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound J Bone Joint Surg Am 79 961–73 Occurrence Handle1:STN:280:DyaK2sznvVWqsw%3D%3D Occurrence Handle9234872

    CAS  PubMed  Google Scholar 

  3. 3

    VH Frankel K Mizuno (2001) Management of nonunion with pulsed, low-intensity ultrasound therapy — international results Z Szabo JE Lewis GA Fantini RS Savalgi (Eds) Surgical technology international X Universal Medical San Francisco 1–6

    Google Scholar 

  4. 4

    E Mayr V Frankel A Rufer (2000) ArticleTitleUltrasound — an alternative healing method for nonunions? Arch Orthop Trauma Surg 120 1–8 Occurrence Handle1:STN:280:DC%2BD3c7hs1OqtA%3D%3D Occurrence Handle10653095

    CAS  PubMed  Google Scholar 

  5. 5

    D Gebauer E Mayr E Orthner JP Ryaby (2005) ArticleTitleLow-intensity pulsed ultrasound: effects on nonunions Ultrasound Med Biol 31 1391–402 10.1016/j.ultrasmedbio.2005.06.002 Occurrence Handle10.1016/j.ultrasmedbio.2005.06.002 Occurrence Handle16223643

    Article  PubMed  Google Scholar 

  6. 6

    K Mizuno Y Yamano M Itoman T Matsushita T Kurokawa T Inoue (2003) ArticleTitleEffects of low-intensity pulsed ultrasound therapy for delayed unions and nonunions: a multicenter clinical study Seikei Saigaigeka (Orthop Surg Traumatol) 46 757–65

    Google Scholar 

  7. 7

    BG Weber OR Cech (1976) Pseudoarthrosis Hans-Huber Bern

    Google Scholar 

  8. 8

    T Kokubu N Matsui H Fujioka M Tsunoda K Mizuno (1999) ArticleTitleLow-intensity pulsed ultrasound exposure increases prostaglandin E2 production via the induction of cyclooxygenase-2 mRNA in mouse osteoblasts Biochem Biophys Res Commun 256 284–7 10.1006/bbrc.1999.0318 Occurrence Handle10.1006/bbrc.1999.0318 Occurrence Handle1:CAS:528:DyaK1MXhvVaiurk%3D Occurrence Handle10079177

    Article  CAS  PubMed  Google Scholar 

  9. 9

    K Naruse Y Mikuni-Takagaki Y Azuma M Ito T Oota K Kameyama et al. (2000) ArticleTitleAnabolic response of mouse bone-marrow-derived stromal cell clone ST2 cells to low-intensity pulsed ultrasound Biochem Biphys Res Commun 268 216–20 10.1006/bbrc.2000.2094 Occurrence Handle10.1006/bbrc.2000.2094 Occurrence Handle1:CAS:528:DC%2BD3cXnsVWhsA%3D%3D

    Article  CAS  Google Scholar 

  10. 10

    J Parvizi C-C Wu DG Lewallen JF Greenleaf ME Bolander (1999) ArticleTitleLow-intensity ultrasound stimulates proteoglycan synthesis in rat chondrocytes by increasing aggrecan gene expression J Orthop Res 17 488–94 10.1002/jor.1100170405 Occurrence Handle10.1002/jor.1100170405 Occurrence Handle1:CAS:528:DyaK1MXlvVOjtbw%3D Occurrence Handle10459753

    Article  CAS  PubMed  Google Scholar 

  11. 11

    K-H Yang J Parvizi S-J Wang DG Lewallen RR Kinnick JF Greenleaf et al. (1996) ArticleTitleExposure to low-intensity ultrasound increases aggrecan gene expression in a rat femur fracture model J Orthop Res 14 802–9 10.1002/jor.1100140518 Occurrence Handle10.1002/jor.1100140518 Occurrence Handle1:STN:280:DyaK2s%2FkvFSntw%3D%3D Occurrence Handle8893775

    Article  CAS  PubMed  Google Scholar 

  12. 12

    S Jingushi Y Iwamoto Y Azuma M Itoh Y Harada H Takagi et al. (1999) ArticleTitleEffects of noninvasive pulsed low-intensity ultrasound on rat femoral fracture Kossetsu (Fracture) 21 655–8

    Google Scholar 

  13. 13

    S-J Wang DG Lewallen ME Bolander EYS Chao DM Ilstrup JF Greensleaf (1994) ArticleTitleLow-intensity ultrasound treatment increases strength in a rat femoral fracture model J Orthop Res 12 40–7 10.1002/jor.1100120106 Occurrence Handle10.1002/jor.1100120106 Occurrence Handle1:STN:280:DyaK2c7lslOiuw%3D%3D Occurrence Handle8113941

    Article  CAS  PubMed  Google Scholar 

  14. 14

    Y Azuma M Ito Y Harada H Takagi T Ohta S Jingushi (2001) ArticleTitleLow-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus J Bone Miner Res 16 671–80 10.1359/jbmr.2001.16.4.671 Occurrence Handle10.1359/jbmr.2001.16.4.671 Occurrence Handle1:STN:280:DC%2BD3MvlvFKrug%3D%3D Occurrence Handle11315994

    Article  CAS  PubMed  Google Scholar 

  15. 15

    A Iwaki S Jingushi Y Oda T Izumi J Shida M Tsuneyoshi et al. (1997) ArticleTitleLocalization and quantification of proliferating cells during rat fracture repair — detection of proliferating cell nuclear antigen by immunohistochemistry J Bone Miner Res 12 96–102 10.1359/jbmr.1997.12.1.96 Occurrence Handle10.1359/jbmr.1997.12.1.96 Occurrence Handle1:STN:280:DyaK2szot1Onug%3D%3D Occurrence Handle9240731

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Seiya Jingushi.

About this article

Cite this article

Jingushi, S., Mizuno, K., Matsushita, T. et al. Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures. J Orthop Sci 12, 35 (2007). https://doi.org/10.1007/s00776-006-1080-3

Download citation

Keywords

  • Bone Fracture
  • Fracture Site
  • Union Rate
  • Fracture Repair
  • Recent Operation