In vivo effect of shock-waves on the healing of fractured bone

doi:10.1016/0268-0033(95)00009-A

Clinical Biomechanics

Volume 10, Issue 7, October 1995, Pages 374-378

https://doi.org/10.1016/0268-0033(95)00009-A Get rights and content

Abstract

In a controlled animal experiment we attempted to clarify the question of whether there is a stimulating effect of extracorporeal shock-waves on the repair process of fractured long bones. As a fracture model we used an osteotomy in the diaphysis of the ovine tibia and an external fixation device. Shock-wave treatment at two levels of intensity and with four different numbers of applied shocks was performed with an electromagnetic acoustic source. Healing of the osteotomized bone was evaluated by biomechanical and radiological investigations on the whole bone as well as on bone sections from areas of the fracture gap and the periosteal fracture callus. We found a non-significant tendency to deterioration of the fracture healing with increasing shock-wave intensities. The study of treatment parameters led neither to significantly different biomechanical outcomes nor to altered radiological results in comparison to the untreated control group.

References (25)

DT Davy et al.
The biomechanical behavior of healing canine radii and ribs
J Biomech
(1982)
LD Yeaman et al.
Effects of shock waves on the structure and growth of the immature rat epiphysis
J Urol
(1989)
CN Cornell et al.
Newest factors in fracture healing
Clin Orthop Rel Res
(1992)
HM Frost
The biology of fracture healing
Clin Orthop Rel Res
(1989)
DJ Simmons
Fracture healing perspectives
Clin Orthop Rel Res
(1985)
EJ Cheal et al.
Role of interfragmentary strain in fracture healing: ovine model of a healing osteotomy
J Orthop Res
(1991)
SM Perrea
Physical and biological aspects of fracture healing with special reference to internal fixation
Clin Orthop
(1979)
RK Schenk
Histophysiology of bone remodelling and bone repair
B McKibbin
The biology of fracture healing in long bones
J Bone Joint Surg
(1978)
A Sarmiento et al.
Fracture healing in the rat femora as affected by functional weight bearing
J Bone Joint Surg
(1977)

RK Schenk et al.

Experimentell-histologischer Beitrag zur Entstehung und Behandlung von Pseudarthrosen

Hefte zur Unfallheilkunde

(1968)

L Claes

Interfragmentary strain and bone healing —an experimental study

Cited by (44)

Pulsed waves for medical therapy
2023, Power Ultrasonics: Applications of High-Intensity Ultrasound, Second Edition
The use of shock waves for medical therapy has been driven by the success of shock wave lithotripsy (SWL) which revolutionized the treatment of kidney stones and remains one of the first-line treatments to this day. The use of shock waves for other medical conditions has been explored in the subsequent four decades with indications including: gall stones, joint pain (including calcifications), tendon pain, nonhealing bone fractures, chronic wound repair, loss of blood supply to the heart tissue, and even brain disorders. Over the same period new devices have been developed and approved with the general trend being to make smaller, more portable, and cheaper systems. This chapter reviews the technology that is used to create shock waves, or in the case of some newer devices pulsed acoustic waves, that are used in clinical applications. It also reviews the clinical literature for some of the indications to show where successes have been achieved and where challenges remain.
Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid
2010, Ultrasound in Medicine and Biology
Citation Excerpt :
We suggest that shockwaves (SW) could be helpful to heal the delayed fractured scaphoid (Bara and Synder 2007; Schaden et al. 2001; Moretti et al. 2009; Xu et al. 2009). On the other hand, some authors conclude that SW have no beneficial effect in fracture repair (Augat et al. 1995; Biedermann et al. 2003). Nevertheless, there is a general consensus that complete consolidation can be obtained by stabilizing the area and the district vascularization.
The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm² ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28–74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5–74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder. (E-mail: [email protected])
Shockwave Exerts Osteogenic Effect on Osteoporotic Bone In an Ovariectomized Goat Model
2009, Ultrasound in Medicine and Biology
Citation Excerpt :
Therefore, the reaction of trabeculae in osteoporotic bone to shockwave stimulation was investigated in this study. In previous animal studies (Augat et al. 1995; Johannes et al. 1994; Narasaki et al. 2003), ESW settings of 0.42 mJ/mm2 X 6000 pulses, 0.54 mJ/mm2 (14.5 kV) X 4000 pulses and 16 kV X 3000 pulses were used on fractured bone of rabbits, dogs and sheep, respectively. Because we used intact bone in this study, a higher dose of 0.50 mJ/mm2 (14 kV) X 6000 pulses was used to compensate for the loss of shockwave energy at the cortical cortex (Ogden et al. 2001).
Our recent in vitro study showed that extracorporeal shock wave (ESW) stimulated calcium deposition in human periosteal cells. In this study, we hypothesized that the use of ESW could induce new bone formation in osteoporotic bone. Using our established osteoporotic goat model, the calcaneus, distal radius and femoral condyle of the left limb were treated with ESW once per month; the contralateral side served as the control. Bone mineral density (BMD), microarchitecture and dynamic histomorphometric index were evaluated after 9 months. Trabecular BMD of the calcaneus increased significantly by 2.90%. This finding was substantiated by micro-computed tomography findings showing that trabecular bone volume fraction and trabecular thickness of the treated calcaneus were enhanced compared with the contralateral control. However, significant difference could not be detected in the other two weight-bearing skeletal sites. Mineral apposition rates of all ESW-treated regions were also consistently higher than those of the control. These findings suggest that ESW treatment could enhance local BMD by inducing new bone formation, yet the effect was more apparent in non-weight-bearing sites. (E-mail: [email protected])
Shock wave treatment shows dose-dependent enhancement of bone mass and bone strength after fracture of the femur
2004, Bone
Shock wave treatment is believed to improve bone healing after fracture. The purpose of this study was to evaluate the effect of shock wave treatment on bone mass and bone strength after fracture of the femur in a rabbit model. A standardized closed fracture of the right femur was created with a three-point bending method in 24 New Zealand white rabbits. Animals were randomly divided into three groups: (1) control (no shock wave treatment), (2) low-energy (shock wave treatment at 0.18 mJ/mm² energy flux density with 2000 impulses), and (3) high-energy (shock wave treatment at 0.47 mJ/mm² energy flux density with 4000 impulses). Bone mass (bone mineral density (BMD), callus formation, ash and calcium contents) and bone strength (peak load, peak stress and modulus of elasticity) were assessed at 12 and 24 weeks after shock wave treatment. While the BMD values of the high-energy group were significantly higher than the control group (P = 0.021), the BMD values between the low-energy and control groups were not statistically significant (P = 0.358). The high-energy group showed significantly more callus formation (P < 0.001), higher ash content (P < 0.001) and calcium content (P = 0.003) than the control and low-energy groups. With regard to bone strength, the high-energy group showed significantly higher peak load (P = 0.012), peak stress (P = 0.015) and modulus of elasticity (P = 0.011) than the low-energy and control groups. Overall, the effect of shock wave treatment on bone mass and bone strength appears to be dose dependent in acute fracture healing in rabbits.
The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves
2022, Biomedicines
Replacement, refinement, and reduction: Necessity of standardization and computational models for long bone fracture repair in animals
2014, Journal of Biomedical Materials Research - Part A

View all citing articles on Scopus

View full text

PaperIn vivo effect of shock-waves on the healing of fractured bone

Abstract

J Biomech

J Urol

Newest factors in fracture healing

Clin Orthop Rel Res

The biology of fracture healing

Clin Orthop Rel Res

Fracture healing perspectives

Clin Orthop Rel Res

Role of interfragmentary strain in fracture healing: ovine model of a healing osteotomy

J Orthop Res

Physical and biological aspects of fracture healing with special reference to internal fixation

Clin Orthop

Histophysiology of bone remodelling and bone repair

The biology of fracture healing in long bones

J Bone Joint Surg

Fracture healing in the rat femora as affected by functional weight bearing

J Bone Joint Surg

Experimentell-histologischer Beitrag zur Entstehung und Behandlung von Pseudarthrosen

Hefte zur Unfallheilkunde

Interfragmentary strain and bone healing —an experimental study

Paper
In vivo effect of shock-waves on the healing of fractured bone