Efficacy of low-intensity pulsed ultrasound treatment for surgically managed fresh diaphyseal fractures of the lower ext
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ORIGINAL ARTICLE
Efficacy of low-intensity pulsed ultrasound treatment for surgically managed fresh diaphyseal fractures of the lower extremity: multi-center retrospective cohort study Yo Kinami • Tomoyuki Noda • Toshifumi Ozaki
Received: 16 April 2012 / Accepted: 17 January 2013 / Published online: 6 March 2013 Ó The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Background There are no evidence on the effects of lowintensity pulsed ultrasound (LIPUS) on surgically managed fresh fractures. We therefore performed a multicenter retrospective cohort study to investigate the effects of LIPUS on surgically managed fresh fractures. Methods This study included patients surgically treated for diaphyseal fractures of the femur or tibia between August 2009 and July 2010 at 14 institutions. Outcome was the union period. We performed an overall comparison of the LIPUS group (78 cases) with the control group (63 cases), as well as subgroup analyses comparing outcomes for fracture sites, fracture types, soft tissue conditions, and fixation methods between the groups. Results There was no significant difference between the groups in terms of distribution of cases by fracture site, fracture type, soft tissue condition, fixation method. Analyses comparing subgroups, however, showed significant Y. Kinami (&) Department of Community Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan e-mail: [email protected] T. Noda Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan T. Ozaki Department of Science of Functional Recovery and Reconstruction (Orthopedic Surgery), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama 700-8558, Japan
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differences between the two groups, particularly in relation to type C fractures, regardless of whether all cases or only closed-fracture cases were analyzed: there was an approximately 30 % reduction in the union period for type C fractures in the LIPUS group. There were also cases requiring reoperation due to lack of stability, even among the type C fractures. Conclusions LIPUS is effective for surgically managed, fresh, type C comminuted diaphyseal fractures of the lower limbs when there is appropriate stability at the fracture site. Introduction The conditions needed for ultrasound-promoted bone union in an animal fracture model were first published by Duarte in 1983 [1]. The effects of low-intensity pulsed ultrasound (LIPUS) on bone union in fracture repair were subsequently confirmed in a range of basic studies. The clinical effects of LIPUS on both conservatively treated fresh fractures and surgically managed fractures with delayed union or nonunion have since been confirmed. In 1998, Japanese health insurance began to cover LIPUS as a treatment for delayed union and nonunion. In 2008, it was a
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