Low-intensity pulsed ultrasound does not influence bone healing by distraction osteogenesis: a multicentre double-blind randomised control trial.
Author: Simpson AH1, Keenan G1, Nayagam S2, Atkins RM3, Marsh D4, Clement ND1
Affiliation:
1Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
2Royal Liverpool Children's and Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK.
3Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
4University College London, 102 Princetown Road, Bangor, BT20 3TG, UK.
Conference/Journal: Bone Joint J.
Date published: 2017 Apr
Other:
Volume ID: 99-B , Issue ID: 4 , Pages: 494-502 , Special Notes: doi: 10.1302/0301-620X.99B4.BJJ-2016-0559.R1. , Word Count: 264
AIMS: The aim of this double-blind prospective randomised controlled trial was to assess whether low intensity pulsed ultrasound (LIPUS) accelerated or enhanced the rate of bone healing in adult patients undergoing distraction osteogenesis.
PATIENTS AND METHODS: A total of 62 adult patients undergoing limb lengthening or bone transport by distraction osteogenesis were randomised to treatment with either an active (n = 32) or a placebo (n = 30) ultrasound device. A standardised corticotomy was performed in the proximal tibial metaphysis and a circular Ilizarov frame was used in all patients. The rate of distraction was also standardised. The primary outcome measure was the time to removal of the frame after adjusting for the length of distraction in days/cm for both the per protocol (PP) and the intention-to-treat (ITT) groups. The assessor was blinded to the form of treatment. A secondary outcome was to identify covariates affecting the time to removal of the frame.
RESULTS: There was no difference in the time to removal of the frame between the PP (difference in favour of the control group was 10.1 days/cm, 95% confidence interval (CI) -3.2 to 23.4, p = 0.054) or ITT (difference 5.0 days/cm, 95% CI -8.2 to 18.21, p = 0.226) groups. The smoking status was the only covariate which increased the time to removal of the frame (hazard ratio 0.47, 95% CI 0.22 to 0.97, p = 0.042).
CONCLUSION: LIPUS does not influence the rate of bone healing in patients who undergo distraction osteogenesis. Smoking may influence bone healing. Cite this article: Bone Joint J 2017;99-B:494-502.
©2017 The British Editorial Society of Bone & Joint Surgery.
KEYWORDS: Exogen; Fracture; Healing; Pulsed; Ultrasound
PMID: 28385939 DOI: 10.1302/0301-620X.99B4.BJJ-2016-0559.R1
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