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Tibial Stress Fracture
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Tibial Stress Fracture - September 19, 2006 5:45:00 AM
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treybien
Posts: 85
Joined: August 5, 2002
From: Milwaukee, WI
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Any information out there about use of bone stimulators for stress fractures?? What is the normal time frame to return to running from the average tibial stress fracture?? Thanks, I know the RehabEdge brain trust will not let me down!
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Re: Tibial Stress Fracture - September 19, 2006 8:04:00 AM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
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There was an article about ultrasound and its effect on fractures in the August 2006 PT Journal.
"Ultrasound Produced by a Conventional Therapeutic Ultrasound Unit Accelerates Fracture Repair
Stuart J Warden, Robyn K Fuchs, Chris K Kessler, Keith G Avin, Ryan E Cardinal and Rena L Stewart
Background and Purpose. A recent novel application of ultrasound therapy is the treatment of bone fractures. The aim of this study was to investigate the effect on fracture repair of ultrasound produced by a conventional therapeutic ultrasound unit as used by physical therapists. Subjects and Methods. Bilateral midshaft femur fractures were created in 30 adult male Long-Evans rats. Ultrasound therapy was commenced on the first day after fracture and introduced 5 days a week for 20 minutes a day. Each animal was treated unilaterally with active ultrasound and contralaterally with inactive ultrasound. Active ultrasound involved a 2-millisecond burst of 1.0-MHz sine waves repeating at 100 Hz. The spatially averaged, temporally averaged intensity was set at 0.1 W/cm2. Animals were killed at 25 and 40 days after fracture induction, and the fractures were assessed for bone mass and strength. Results. There were no differences between fractures treated with active ultrasound and fractures treated with inactive ultrasound at 25 days. However, at 40 days, active ultrasound-treated fractures had 16.9% greater bone mineral content at the fracture site than inactive ultrasound-treated fractures. This change resulted in a 25.8% increase in bone size, as opposed to an increase in bone density, and contributed to active ultrasound-treated fractures having 81.3% greater mechanical strength than inactive ultrasound-treated fractures. Discussion and Conclusion. These data indicate that ultrasound produced by a conventional therapeutic ultrasound unit as traditionally used by physical therapists may be used to facilitate fracture repair. However, careful interpretation of this controlled laboratory study is warranted until its findings are confirmed by clinical trials. [Warden SJ, Fuchs RK, Kessler CK, et al. Ultrasound produced by a conventional therapeutic ultrasound unit accelerates fracture repair. Phys Ther. 2006;86:1118–1127.]"
JMA
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Re: Tibial Stress Fracture - September 19, 2006 10:21:00 AM
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proud
Posts: 944
Joined: March 22, 2006
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Thanks for that JMA. I await the clinical trials.
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Re: Tibial Stress Fracture - September 19, 2006 5:24:00 PM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
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Here's one more, a review done in 2003 on bone stimulators.
"J South Orthop Assoc. 2003 Summer;12(2):46-54. Links
The clinical use of bone stimulators.Anglen J.
University of Missouri Hospital & Clinics, Department of Orthopaedic Surgery, Columbia, MO 65212, USA.
Delay or failure of healing in long bone fracture is a common clinical problem confronting the orthopaedic surgeon, and can have significant impact on the quality of life for patients who have it. One treatment option for this problem is the use of electrical or ultrasonic bone stimulation. Electrical signals can be delivered with an implantable direct current stimulator, or noninvasively using inductive or capacitive coupling to induce currents in the tissues. Low-intensity ultrasound can speed the healing of fresh fractures. Although regarded with skepticism by many physicians, there is abundant evidence from clinical studies of the effectiveness of these treatments. In addition to dozens of retrospective reports, randomized, prospective, double-blind controlled trials have shown the efficacy of electrical stimulation for nonunion and ultrasound for speeding healing. Patients with unacceptable deformity, synovial pseudarthrosis, or large gaps are generally not good candidates for this treatment modality. This article is a review of the clinical literature regarding treatment of long bone nonunion with bone stimulators.
PMID: 12882239 [PubMed - indexed for MEDLINE]"
JMA
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Re: Tibial Stress Fracture - September 20, 2006 2:29:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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I have worked with many patients with tibial stress fractures since they are a very common injury among basic trainee soldiers. The healing times vary and depend on several factors. First, the severity of the stress fracture, which can be quantified by the amount of uptake seen on the bone scan or the amount of signal present on the MRI. If the fracture is plainly visible on the radiographs then this is also an indicator of more severity. The second factor is the age of the patient. I have noticed that naturally the younger soldiers heal quicker than the older soldiers that we get in basic training. Soldiers over 30 seem to take almost twice as long to heal. Third, is the location on the tibia of the fracture. Fractures through the tibial plateau take longer than a mid-shaft fracture for whatever reason; probably because it is an interarticular lesion. Lastly, the body type and prior level of fitness seems to be a factor as to quickness to healing. The soldiers that are larger, non athletic, and who were in fairly poor shape prior to coming into the military seem to heal much slower.
To my knowledge, there is very little hands-on treatment for these injuries. You must rest them, protect them, and promote the best environment for healing. It is difficult to give you a time frame for healing without knowing more information about the severity of the fracture and the patient.
_____________________________
Alex Brenner, PT, MPT, OCS
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