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Friday, October 14, 2011

Low Intensity Ultrasound May Help in Healing Fractures Quickly

Posted by Prahallad Panda on 6:28 PM Comments

Communitive midshaft humeral fracture with cal...Image via Wikipedia
Low intensity ultrasound may help healing fractures, reported in MedicalXpres. Low-intensity pulsed ultrasound (LIPUS) is delivered by a device for 20 minutes per day and is painless.
The LIPUS device comprises a hand held control unit attached by wire to a small ultrasound emitter, which is placed over the fracture site for 20 minutes per day. Patients in this study had all sustained a tibial shaft fracture that subsequently showed inadequate progress toward healing and were randomized to receive either a functional or non-functional device.
The estimated increase in BMD among subjects randomized to active LIPUS treatment was 34% larger. According to Block, "This is the first study to offer Level-I evidence of this effect in a single fracture type".
The Low intensity pulsed ultrasound is a specific ultrasound signal of (1.5 MHz ultrasound pulsed at 1 kHz, 20% duty cycle, 30 mW/cm(2) intensity (SATA)).
In a study it was seen that LIPUS treatment accelerated the healing time in fresh tibia, radius and scaphoid fractures by up to 40%. Additionally, it had been been seen to be effective at resolving all types of nonunions of all ages, following a wide range of fracture types.

Healing of fractures is a complex issue involving many processes in the body. It also depends on the age; pre-existing diseases like chronic kidney disease and osteoporosis; infection of fracture site and proper immobilization etc.. Still, about 5% to 10% of fractures may land in delayed or non-union. Most of fracture healing takes place within six months, whereas it may take 1 year to regain full strength.
LIPUS has been demonstrated to accelerate all stages of the fracture repair process (inflammation, soft callus formation, hard callus formation) through an increase in cell proliferation, protein synthesis, collagen synthesis, membrane permeability, integrin expression, and increased cytosolic Ca(2+) levels as well as other increased indicators of bone repair.
In particular, it accelerated mineralisation with increase in osteocalcin, alkaline phosphatase, VEGF (Vascular Endothelial Growth Factor) and MMP-13 expression. Expression of Integrins, a family of mechanoreceptors present on a wide range of cells are also involved in the fracture healing process.
Downstream of the integrin activation, focal adhesions occur on the surface of cells with the activation of multiple signalling pathways, including the ERK, NF-kappabeta, and PI3 kinase pathways. These pathways have been directly linked to the production of COX-2 and prostaglandin, which are key to the processes of mineralisation and endochondral ossification in fracture healing.
Though considerable amount of information has been revealed about the behavior of osteoblasts under low-intensity pulsed ultrasound exposure, it appears that the exact mechanism of action is complex.
LIPUS with other conventional and novel tissue-regeneration manipulations may be combined to develop new treatment strategies for large-scale bone Injuries.
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