Modalities to stimulate bone growth

A question re bone healing. Does anybody have experience with Shockwave Therapy and bone healing?

Hi Ron, I have good experience with the LIPUS, described by prof. Watson. It was a 86 yo patient with nonhealing proximal humerus comminuted fracture, surgicaly reduced with ORIF. It was not healed for 6 months when we started the LIPUS therapy. After two months there were Rx signs for fracture healing. After that we continiued for 3 or 4 weeks more and than discontiniued the therapy as three indipended orthopedic doctors confirmed that the fracture has healed. The therapy was delivered by a special LIPUS machine, called Osteotron, which I believe was made in Japan. The parameters were exactly as the described by prof. Watson. Hope it helps.

Georgi

Prof Tim Watson said:

By way of confirming other comments in this discussion, Ultrasound in pulsed mode is not contraindicated when there is metal in the tissues. It is almost certain that even in continuous mode, it would be safe, but most practioners take the path of caution and avoid continuous mode when there is metal. The dose of ultrasound which stimulates bone healing, and which is evidenced as being of clinical value is commonly known as LIPUS (Low Intensity Pulsed Ultrasound) and is at a MUCH lower dose than a standard therapy ultrasound machine can deliver. I have a page on the website about it (http://www.electrotherapy.org/modality/ultrasound-for-fracture-healing-low-intensity-pulsed-ultrasound--lipus) and there is a pdf file which can be downloaded from (predictably) the download page (http://www.electrotherapy.org/downloads). I have a stack of new papers on the topic so both the web page and the pdf file are on my list of things to update - but the essential information is valid. The dose employed with LIPUS is at 1.5MHz using an intensity of 0.03W cm2 (sometimes described as 30mW/cm2), pulsed at 1000Hz delivered for 20 minutes daily with a stationary application technique. I have not found any evidence that a standard therapy ultrasound machine has been used in a clinical trial for this bone healing effect.

There are a lot of other modalities which have some evidence of benefit for fracture healing including : Laser, Pulsed Shortwave; various magnetic and pulsed magnetic field based therapies; several Electrical Stimulation modes. They are all supported by some evidence. My reading of the literature to date is that given a choice, the LIPUS ultrasound is the most strongly evidenced of this raft of options

Tim

Perfect!

By way of confirming other comments in this discussion, Ultrasound in pulsed mode is not contraindicated when there is metal in the tissues. It is almost certain that even in continuous mode, it would be safe, but most practioners take the path of caution and avoid continuous mode when there is metal. The dose of ultrasound which stimulates bone healing, and which is evidenced as being of clinical value is commonly known as LIPUS (Low Intensity Pulsed Ultrasound) and is at a MUCH lower dose than a standard therapy ultrasound machine can deliver. I have a page on the website about it (http://www.electrotherapy.org/modality/ultrasound-for-fracture-healing-low-intensity-pulsed-ultrasound--lipus) and there is a pdf file which can be downloaded from (predictably) the download page (http://www.electrotherapy.org/downloads). I have a stack of new papers on the topic so both the web page and the pdf file are on my list of things to update - but the essential information is valid. The dose employed with LIPUS is at 1.5MHz using an intensity of 0.03W cm2 (sometimes described as 30mW/cm2), pulsed at 1000Hz delivered for 20 minutes daily with a stationary application technique. I have not found any evidence that a standard therapy ultrasound machine has been used in a clinical trial for this bone healing effect.

There are a lot of other modalities which have some evidence of benefit for fracture healing including : Laser, Pulsed Shortwave; various magnetic and pulsed magnetic field based therapies; several Electrical Stimulation modes. They are all supported by some evidence. My reading of the literature to date is that given a choice, the LIPUS ultrasound is the most strongly evidenced of this raft of options

Tim

fisioniki289 said:

International Guideline said no contraindication for US and metal implant (except continuous and fixed mode) because metal reflects US, no heating.

Another therapy is MAGNETOTHERAPY, or PEMFs (low-frequency electromagnetic fields). IS PERFECT FOR BONES.

Considering the anatomical area, at least, you can work with High Tension Current.

Can you provide a link/send the guidelines?

Thanks!

International Guideline said no contraindication for US and metal implant (except continuous and fixed mode) because metal reflects US, no heating.

Another therapy is MAGNETOTHERAPY, or PEMFs (low-frequency electromagnetic fields). IS PERFECT FOR BONES.

Considering the anatomical area, at least, you can work with High Tension Current.

vetphysio.herbots113 said:

Hi To my knowledge and experience, US is only forbidden if you use it in a continuous setting, because of heating effects. So normally when you work in pulsed modus it is ok. To clarify, my experience is in dogs, but in 2002 we did a study on 5 dogs, incuding one with osteosynthesis material. I'm now giving presentations about physio in animals in Taiwan and Thailand. I'll be home next week if you like I can send you a copy of the article. Please recall me

Patrick

Hi Patrick, I am interested in your presentations. I will appreciate if you can send me a copy too via egbonfasuba@gmail.com

Thanks

Hi Ronald, TENS was used to manage a case of delayed union of the femur (shaft) during my clinical training in school. I searched the net to back it up with published articles but I couldn't assessed them. I will appreciate if you do a corresponding search on this. However, during the search, I came across the following; http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?AccessionNumber=12009102012&UserID=0 http://bjj.boneandjoint.org.uk/content/jbjsbr/62-B/4/465.full.pdf

I hope they will be useful.

Best Wishes...

Hi To my knowledge and experience, US is only forbidden if you use it in a continuous setting, because of heating effects. So normally when you work in pulsed modus it is ok. To clarify, my experience is in dogs, but in 2002 we did a study on 5 dogs, incuding one with osteosynthesis material. I'm now giving presentations about physio in animals in Taiwan and Thailand. I'll be home next week if you like I can send you a copy of the article. Please recall me

Patrick

Hi To my knowledge and experience, US is only forbidden if you use it in a continuous setting, because of heating effects. So normally when you work in pulsed modus it is ok. To clarify, my experience is in dogs, but in 2002 we did a study on 5 dogs, incuding one with osteosynthesis material. I'm now giving presentations about physio in animals in Taiwan and Thailand. I'll be home next week if you like I can send you a copy of the article. Please recall me

Patrick