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ultrasound and fractures
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ultrasound and fractures - May 22, 2007 3:18:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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Ultrasound Treatment May Speed Healing in Fractures
(Elsevier Global Medical News - 05/17/2007)
Mohit Bhandari
QUEBEC CITY (EGMN) - Low-intensity pulsed ultrasound treatment can speed up bone healing by a mean of 64 days and is a reasonable consideration for fresh fractures, according to Dr. Mohit Bhandari, an orthopedic trauma surgeon at McMaster University in Hamilton, Ont.
“There is an absolute demand these days for fast recovery. The urgency is even greater in athletes,” he said at the joint annual meeting of the Canadian Academy of Sport Medicine and the Association Québécoise des Médecins du Sport.
In an earlier meta-analysis of low intensity pulsed ultrasound (LIPUS) for fresh fractures, Dr. Bhandari said he found a faster median time to healing of 30 days for scaphoid fractures, 61 days for distal radius fractures, and 67 days for tibial shaft fractures, compared with controls - and an overall faster median time to healing of 64 days, a clinically significant difference (CMAJ 2002;166:437-41).
In a recent survey of 300 orthopedic surgeons in Canada (submitted for publication by the Journal of Orthopaedic Trauma), a healing time of 30 days was considered clinically important, he said in an interview.
However, Dr. Bhandari noted, published studies evaluating treatment of fractures with ultrasound have been small and their data unconvincing.
As a result, the medical community’s response to LIPUS has been muted. Dr. Bhandari’s recent findings showed that about half of the 300 surgeons used some form of bone-stimulation treatment for difficult fractures: Forty-five percent of them used ultrasound, 45% used electrical stimulation, and the rest used “other.” And another survey, in 2004, showed that 32% of surgeons and 21% of physiotherapy students believed that ultrasound could actually be harmful to healing bones (Arch. Phys. Med. Rehabil. 2004;85:1653-6).
The published evidence in favor of LIPUS applies to fresh, nonoperative fractures, but there also is evidence that ultrasound can be effective in operative treatment, said Dr. Bhandari. He and his fellow researchers are currently enrolling patients for the multinational randomized controlled TRUST study (Trial to Reevaluate Ultrasound in the Treatment of Tibial Fractures) to compare ultrasound and placebo in tibial fractures treated with intramedullary nails.
“We believe there is likely an important effect that previous studies were unable to elucidate due to small sample sizes,” he said of the study, which aims to enroll 500 patients. It is funded by the Canadian Institute of Health Research and Exogen Inc. (Smith and Nephew, United Kingdom). Dr. Bhandari disclosed no business relationship with Exogen, which manufactures a LIPUS device.
He noted that the evidence for ultrasound treatment of nonunions (fractures with delayed healing) was even weaker. “There is some suggestion of benefit with nonunions, but we need more studies to refute or confirm this.”
However, Dr. Nick Mohtadi, an orthopedic surgeon at the University of Calgary (Alta.), emphasized that the evidence would need to be well established because the technology is costly. “The number of nonunions is so small that the market for that type of thing is minimal. But if you’re talking about fresh fractures and healing people earlier, then it’s billions.”
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: ultrasound and fractures - May 22, 2007 4:04:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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have you ever had US on a undiagnosed Fx...unpleasant is an understatement. Pulsed or not, I've used US as a non-scientific method of trying to confirm a suspected hairline fracture, it hurts real bad on fractures.....not sure how many people will let it be done to them.
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Re: ultrasound and fractures - May 22, 2007 4:55:00 PM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Ben, this is LIPUS, which is a much lower intensity than regular clinical US. Shame on you Ben...you have not been reading your PTupdate material, as I did cover an article on this from an Australian journal.
Actually, after reading, I began to inquire, figuring that if we could speed up fracture time from 6 to 4 weeks, it could be a boon for business. Richmar makes the Autosound, but since US is billed as a constant attendance modality, going that route could prove to be fraud. Thus, performing manual LIPUS for the times required does not make it worth the time
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: ultrasound and fractures - May 24, 2007 6:03:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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lol, sorry, i am guilty as charged. I have been out of the loop starting my new business. i am the new EBM for physicians, woohoo, then again as you said, mainly because it pays well ;) i will check it out-
ben
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Re: ultrasound and fractures - May 27, 2007 5:18:00 AM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
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I have seen some patients, post spine surgeries wearing a bone stimulator on their backs. Never used US or ever read a script that warranted a use for it.
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