Effect of low-intensity pulsed ultrasound on fracture callus mineral density and flexural strength in rabbit tibial fresh fracture

BackgroundLow-intensity ultrasound is a biophysical intervention on a fracture repair process. However, the effect of low-intensity ultrasound therapy on fracture healing is controversial. The aim of the present study was to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) therapy on the fracture healing process, including mineral density and strength of callus using a rabbit model.MethodsA total of 30 rabbits underwent unilateral, transverse, and mid-tibia open osteotomies that were stabilized with external fixators. Then, the animals were divided into two study groups composed of 15 rabbits each: the case group (US), which were exposed to low-intensity pulsed ultrasound with 30 mW/cm2 intensity and 1.5 MHz sine waves; and the control group (C), which underwent sham ultrasound treatment. Callus development and mineral density were evaluated using multidetector computed tomography at 2, 5, and 8 weeks, after which the animals were killed. Three-point bending tests of both healed and intact bones were assessed and compared.ResultsThe results demonstrated that the callus mineral density in the US group was higher than in the C group (1202.20 ± 81.30 vs. 940.66 ± 151.58 HU; P = 0.001) at the end of the 8th week. The mean recorded three-point bending test score of healed bones in the US group was not significantly different from that of the C group (359.35 ± 173.39 vs. 311.02 ± 80.58 N; P = 0.114).ConclusionsThe present study showed that low-intensity pulsed ultrasound enhanced callus mineral density with an insignificant increase in the strength of the fractured bone.

[1]  Y. Mikuni‐Takagaki,et al.  Distinct Anabolic Response of Osteoblast to Low‐Intensity Pulsed Ultrasound , 2003, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[2]  E. Chao,et al.  The effect of low intensity pulsed ultrasound applied to rabbit tibiae during the consolidation phase of distraction osteogenesis , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  J. Ryaby,et al.  Accelerated Healing of Distal Radial Fractures with the Use of Specific, Low-Intensity Ultrasound. A Multicenter, Prospective, Randomized, Double-Blind, Placebo-Controlled Study* , 1997, The Journal of bone and joint surgery. American volume.

[4]  Y. Azuma,et al.  Anabolic response of mouse bone-marrow-derived stromal cell clone ST2 cells to low-intensity pulsed ultrasound. , 2000, Biochemical and biophysical research communications.

[5]  M. Dyson,et al.  Stimulation of bone repair by ultrasound. , 1985, Ultrasound in medicine & biology.

[6]  Dimitrios I Fotiadis,et al.  Transosseous application of low-intensity ultrasound for the enhancement and monitoring of fracture healing process in a sheep osteotomy model. , 2006, Bone.

[7]  Michael H. Repacholi,et al.  Ultrasound: Medical Applications, Biological Effects, and Hazard Potential , 1987 .

[8]  J F Greenleaf,et al.  Low‐intensity ultrasound stimulates proteoglycan synthesis in rat chondrocytes by increasing aggrecan gene expression , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  Javad Parvizi,et al.  Exposure to low‐intensity ultrasound increases aggrecan gene expression in a rat femur fracture model , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  T. Jämsä,et al.  The mechanical strength of bone in different rat models of experimental osteoporosis. , 1994, Bone.

[11]  Apostolos H Karantanas,et al.  Low-intensity transosseous ultrasound accelerates osteotomy healing in a sheep fracture model. , 2004, The Journal of bone and joint surgery. American volume.

[12]  J. Zanchetta,et al.  Interrelationships between densitometric, geometric, and mechanical properties of rat femora: Inferences concerning mechanical regulation of bone modeling , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[13]  Y Yamano,et al.  Low-intensity pulsed ultrasound accelerates bone maturation in distraction osteogenesis in rabbits. , 2000, The Journal of bone and joint surgery. British volume.

[14]  Marvin C. Ziskin,et al.  Applications of Ultrasound in Medicine — Comparison with Other Modalities , 1987 .

[15]  Ling Qin,et al.  Low intensity pulsed ultrasound increases the matrix hardness of the healing tissues at bone-tendon insertion-a partial patellectomy model in rabbits. , 2006, Clinical biomechanics.

[16]  J. C. Lin,et al.  Cytokine release from osteoblasts in response to ultrasound stimulation. , 2003, Biomaterials.

[17]  E. Chao,et al.  Low intensity ultrasound treatment increases strength in a rat femoral fracture model , 1994, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  A. Emami,et al.  No effect of low-intensity ultrasound on healing time of intramedullary fixed tibial fractures. , 1999, Journal of orthopaedic trauma.

[19]  Eric Hume,et al.  Power Doppler Assessment of Vascular Changes During Fracture Treatment With Low‐Intensity Ultrasound , 2003, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[20]  L. Qin,et al.  Low intensity pulsed ultrasound accelerated bone remodeling during consolidation stage of distraction osteogenesis , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  R F Kilcoyne,et al.  Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. , 1994, The Journal of bone and joint surgery. American volume.

[22]  Y. Harada,et al.  Low‐Intensity Pulsed Ultrasound Accelerates Rat Femoral Fracture Healing by Acting on the Various Cellular Reactions in the Fracture Callus , 2001, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[23]  T A Einhorn,et al.  Enhancement of fracture-healing. , 1995, The Journal of bone and joint surgery. American volume.