1. Literature Review of the Effectiveness of Low Intensity Pulsed Ultrasound on Fracture Healing Nicole Boyko, Carrie Jose, Bridget Promaulayko, Christy Silva

2. Introduction 850,000 fx/yr among people > 65 3% falls in elderly = fx common fx sites: hip, pelvis, femur, vertebrae, humerus, hand, forearm, leg, ankle 340,000 hospital admits for hip fx in 1996; avg 2 wks duration; 50% unable to live (I) after D/C

3. Introduction Medical Costs 2° fx: –1986: $7-10 billion –1995: $13 billion 3% of all Medicare costs expended on fx

4. Review of Pathophysiology Inflammatory Phase Reparative Phase Remodeling Phase

5. Rationale Previous thoughts on US Vs current literature Need for accelerated method of fx healing –length of rehab stay –medical costs –increased number of fractures –decreased functional mobility

6. Purpose Investigate current literature to determine efficacy of ultrasound on fx healing Propose change in current physical therapy practice

7. Background/Literature Review Subject/Methods: –32 rats (64 fx: 32 exp., 32 control) –4 groups:US, US control, ES, ES control –ES: DC at 10µA x 30min/day x 15 days –US: pulsed at 0.1 W/cm² x 2min every other day –control groups received placebo Rx –measurements on day 7 and day 14

8. Background/Literature Review Results –callus formation  cartilage tiss. in exp. grp; fibrous tiss. in ctrl grp –early bone formation  in exp. grp only –  calcified cartilage=  mineralization=  bony union –  vascularization & osteoblastic activity

9. Background/Literature Review Subjects/Methods: –67 closed or gr I open tibial diaphyseal fx in human subjects –multi-institutional, prospective, randomized, double-blind, placebo controlled study –both groups: CR & above knee cast –exp. group: PUS 1.5MHz at 30mW/cm² x 20 min/day x 20 wks (or sufficient healing)

10. Background/Literature Review X-Rays at 4, 6, 8, 10,12, 14, 20, 33, and 52 wks Results –time to clin healing: 86 days active Vs 114 days placebo –time to cast removal: 94 Vs 120 days –complete cortical bridging: 114 Vs 182 days –endosteal healing: 117 Vs 167 days

11. Background/Literature Review Subjects/Methods –60 pts (61 distal radial fx) –enrolled in study 7 days post-fx –multi-institutional, prospective, randomized, double-blind, placebo controlled study –each subject randomly assigned home US unit (SAFHS) –31 placebo, 30 active US –US: 20 min/day x 10 wks at 30 mW/cm²

13. Background/Literature Review X-Ray/exam wks 1-6, 8, 10, 12, 16 Compliance –Pt logs –Internal record of use in US device Results –No adverse effects 2° US –Healing accelerated by 37 days (both cortical and trabecular bone –time to healing:61 +/- 3 days exp. 98 +/- 5 days ctrl

14. Background/Literature Review Subjects/Methods: –42 patients out of a 3 yr. study involving 951 delayed union and 366 nonunion fx’s. –US Rx: one daily 20 min. pd, self- administered at home with the SAFHS at 1.5 MHz, pulsed, 30mW/cm².

15. Background/Literature Review Results: –Data stratified for healing rate, healing time, SD error of mean, avg fx age. –Analyzed by t-test –Delayed unions: healing rate 91%, healing time avg 129+/- 2.7 days, avg fx age 150 days –Nonunions: healing rate 86%, avg healing time 152+/-5.3 days, avg fx age > 2 yrs.

16. Background/Literature Review Factors in Healing: –Age –Surgical Procedures prior to US –Prescribed drugs –Additional diseases –Smoking Hx

17. Proposed Changes Low Intensity Pulsed Ultrasound should be indicated in the Rx of unhealed fractures Self-Administration at home Vs. PT clinic

18. Summary/Conclusion Benefits of Low Intensity Pulsed US –  fx healing time and rate –promotes osteogenesis –easily incorporated into conventional Rx –pt can self-administer at home after PT education in clinic Future research in parameters

19. Questions?????