Malizos_edit.qxp 2/5/07 11:56 am Page 87
Orthopaedic Surgery Fracture Repair
Stimulation and Monitoring of Bone-fracture Healing Using
Transosseous Ultrasound Waves
a report by
Konstantinos N Malizos,
1
Vasilios C Protopappas
2
and Dimitrios I Fotiadis
2
1. President, European Bone and Joint Infection Society; 2. Institute of Biomedical Research and Technology, Larissa; 3. University of Thessaly
Millions of fractures occur annually as a result of traumatic injuries or Percutaneous LiPUS in the Management of Fresh
pathological conditions. Fractured bone has a remarkable ability to Fractures and Established Non-unions
undergo repair through a self-regulated regenerative process of callus The first clinical evidence of the positive effect of LiPUS on the bone-
formation and consolidation. As a biological process, fracture healing healing process was observed as early as the 1950s. Mainly during the
involves the spatial and temporal co-ordinated action of many different last two decades of the 20th century, in vitro studies, experimental
cell types and proteins and the expression of hundreds of genes, all fractures on animal models,
2
clinical trials
3
and case studies have
working together towards the gradual restoration of the structural, demonstrated that the LiPUS treatment enables earlier weight bearing,
mechanical and functional properties of the bone. increases the strength of the healing bone and accelerates the healing
time of fresh fractures by up to 38%.
3
Also, LiPUS minimises the risk
Although most fractures will successfully heal within a few months, of non-healing and enhances callus formation in delayed unions and
5–10% of cases experience complications, such as delayed union or non- established non-unions.
4
union, which require further conventional or surgical procedures. In both
types of complication, the already prolonged treatment period further LiPUS is currently applied percutaneously via the manual attachment of
extends and the substantial morbidity of the patient interferes with the an ultrasound probe to the skin at the site of a fracture. The treatment
human activity and vocational productivity, becoming a major cause of is performed for 20 minutes daily (frequency: 1.5 megahertz, average
direct and indirect personal, societal and health-care-system costs. intensity: 30 milliwatts per square centimetre (mW/cm
2
). LiPUS
treatment can contribute significantly to cost-savings for third-party
payers, employers and government funds by minimising the need for
secondary procedures and reducing workers’ compensation payments.
Considering that the tibia is the most commonly fractured long bone
Secondary surgical procedures and
and is associated with a high incidence of delayed union and
the harvesting of bone grafts result in
non-union, it has been estimated that the economics of treating
tibial fractures are reduced overall by approximately US$13–15,000.
additional suffering, pain and risk
of infection.
Professor Konstantinos N Malizos is President of the European
Bone and Joint Infection Society. He currently serves as
Professor and Chairman of Orthopaedics, School of Health
Sciences, University of Thessaly, Greece. Professor Malizos is
also Director of the Institute of Biomedical Research &
Technology. He is a member of 12 scientific societies and has
Enhancement of Bone Healing
authored more than 100 publications in peer-reviewed
journals, 22 book chapters and two books as editor-author.
In clinical practice, the ‘golden standard’ for the management of non-
He has received nine international awards and prizes.
unions is surgical intervention, stable fixation and biological
E:
kmalizos@otenet.gr
augmentation of the repair process, such as autogenous bone
grafting. However, the secondary surgical procedures and the
Dr Vasilios C Protopappas has been with the Unit of Medical
Technology and Intelligent Information Systems at the
harvesting of bone grafts result in additional suffering, pain and risk of
University of Ioannina since 2000. His research interests
infection and add to the associated expenses. In past decades, include biomechanics, ultrasonic testing, finite element
bioengineering and clinical investigators have envisioned being able to
modelling and medical-device technology.
employ alternative least or non-invasive means to enhance and
stimulate bone healing. These so-called bone growth stimulators (BGS)
include a number of biological interventions,
1
for example bone
Dimitrios I Fotiadis is an Associate Professor in the
morphogenetic protein, as well as biophysical methods. The latter
Department of Computer Science at the University of
include mechanical, electric or electromagnetic stimulation,
1
Ioannina, Greece. He is also Director of the Unit of Medical
extracorporeal shock-wave therapy and low-intensity pulsed
Technology and Intelligent Information Systems, and
President of the Science and Technology Park of Epirus.
ultrasound (LiPUS).
1-6
BGS is a rapidly growing market currently Professor Fotiadis’ research interests include biomedical
estimated to reach 5% of the US$19-billion global orthopaedic
technology, biomechanics, scientific computing and
intelligent information systems.
market, while the compound annual growth rate is expected
to be 7–10%.
© TOUCH BRIEFINGS 2007 87
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100