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Artikelen uit vakliteratuur

A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients.

BMC Musculoskeletal Disorders,
Robert Zura, Samir Mehta, Gregory J. Della Rocca, John Jones, R. Grant Steen


Patient age is one of many potential risk factors for fracture nonunion. Our hypothesis is that older patients (≥ 60) with fracture risk factors treated with low-intensity pulsed ultrasound (LIPUS) have similar heal rate (HR) to the population as a whole. We evaluate the impact of age in conjunction with other risk factors on HR in LIPUS-treated patients with fresh fracture (≤ 90 days old).


The Exogen Bone Healing System is a LIPUS device approved in 1994 to accelerate healing of fresh fracture. After approval, the FDA required a Post-Market Registry to assess performance. Patient data collected from October 1994 until October 1998 were individually reviewed and validated by a registered nurse. Four distinct data elements were required to report a patient: date fracture occurred; date treatment began; date treatment ended; and a dichotomous outcome of healed v. failed, by clinical and radiological criteria. Data were used to calculate two derived variables; days to treatment (DTT) and days on treatment (DOT). Every validated fresh fracture patient with DTT, DOT, and outcome is reported.


The validated registry had 5,765 patients with fresh fracture; 73% (N = 4,190) are reported, while 13% of patients were lost to follow-up, 11% withdrew or were non-compliant, and 3% died or are missing outcome. Among treatment-compliant patients, HR was 96.2%. Logistic estimates of the odds ratio for healing are equivalent for patients age 30 to 79 years and all age cohorts had a HR > 94%. Open fracture, current smoking, diabetes, vascular insufficiency, osteoporosis, cancer, rheumatoid arthritis, and prescription NSAIDs all reduced HR, but older patients (≥ 60) had similar HRs to the population as a whole. DTT was significantly shorter for patients who healed (p < 0.0001).


Comorbid conditions in conjunction with aging can reduce fracture HR. Patients with fracture who used LIPUS had a 96% HR, whereas the expected HR averages 93%. Time to treatment was significantly shorter among patients who healed (p < 0.0001), suggesting that it is beneficial to begin LIPUS treatment early. Older patients (≥ 60) with fracture risk factors treated with LIPUS exhibit similar heal rates to the population as a whole.


Full article available at PubMed.gov.

Low-Intensity Pulsed Ultrasound for Treatment of Fractures and Nonunions - Current Evidence and Insights from Basic Research and Clinical Application

Z Orthop Unfall.,
Randau TM, Kabir K, Gravius S, Wimmer MD, Friedrich MJ, Burger C, Goost H

In Germany, 800,000 fractures are treated per year, and up to 10 % of these patients may suffer subsequently from a delayed union or a nonunion at the fracture site. Surgical treatment of these complications is tedious and associated with high costs. Therefore non-operative treatment is recently receiving more scientific and clinical attention. The adjuvant treatment with ultrasound has been propagated for the past years to enhance fracture healing and bony union, and has been discussed controversially. This review article demonstrates the significance of the low intensity pulsed ultrasound application in fracture treatment, on the basis of basic science results, animal experiments and the results of clinical trials.

Full article available at PubMed.gov.

Acceleration of tibia and distal radius fracture healing in patients who smoke.

Clinical Orthopaedics and Related Research,
Cook SD, Ryaby JP, McCabe J, Frey JJ, Heckman JD, Kristiansen TK

Uit dit onderzoek blijkt dat rokers met een geïndiceerde* tibia- of radiusfractuur sneller genezen bij gebruik van EXOGEN: 41% sneller voor tibiafracturen en 51% sneller voor distale radiusfracturen.

Volledig artikel beschikbaar op PubMed.gov.

Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound.

The Journal of Bone and Joint Surgery,
Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF

In dit onderzoek werd de werkzaamheid van het botgenezingssysteem van EXOGEN aangetoond. Een significant snellere genezingstijd voor verse* fracturen werd waargenomen wanneer EXOGEN werd toegepast gedurende 20 minuten per dag, met een genezingspercentage van 94% van de fracturen in de EXOGEN-groep na 150 dagen.

Volledig artikel beschikbaar op PubMed.gov.

Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study

The Journal of Bone and Joint Surgery,
Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LR

In dit onderzoekx werden 60 patiënten met een verse radiusfractuur gedurende 10 weken behandeld met ofwel EXOGEN ofwel een placebo-apparaat. De gebruikers van EXOGEN hadden een significant kortere tijd tot union, met versnelling die in elke fase van de genezing kon worden aangetoond.

Volledig artikel beschikbaar op PubMed.gov.

Low-intensity pulsed ultrasound in the treatment of nonunions.

The Journal of Trauma,
Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH

Uit dit onderzoek bleek dat EXOGEN van nut kan zijn bij de behandeling van ingewikkelde vastgestelde non-unions, met een totaal genezingspercentage van 86%.

Volledig artikel beschikbaar op PubMed.gov.

Low-intensity pulsed ultrasound: effects on nonunions.

Ultrasound in Medicine and Biology,
Gebauer D, Mayr E, Orthner E, Ryaby JP

In dit onderzoek werden 67 non-unionfracturen behandeld met EXOGEN. Na dagelijks behandeling van 20 minuten was 85% van de non-unions genezen.

Volledig artikel beschikbaar op PubMed.gov.

Improved Healing Response in Delayed Unions of the Tibia with Low-Intensity Pulsed Ultrasound: Results of a Randomized Sham-Controlled Trial

BMC Musculoskeletal Disorders,
Schofer MD, Block JE, Aigner J, Schmelz A

In het eerste niveau I onderzoek betreffende genezingspercentages van non-unions werden 51 patiënten met een vertraagde union van de tibia behandeld met EXOGEN. De gemiddelde verbetering in botmineraaldichtheid was 1,34 keer meer dan die van patiënten die waren behandeld met een sham-apparaat.

Volledig artikel beschikbaar om te downloaden of op PubMed.gov.

Indications and results for the EXOGEN ultrasound system in the management of non-union: a 59-case pilot study.

Orthopaedics, Traumatology, Surgery & Research (OTSR),
Roussignol X, Currey C, Duparc F, Dujardin F.

Dit vooronderzoek had tot doel het gebruik van EXOGEN te beoordelen voor de behandeling van non-unions van het femur of de tibia. Het botgenezingspercentage van 88% (hoger dan bij traditioneel operatief ingrijpen) en een lager kostenplaatje per unit van ten minste 60%, pleiten voor inzet vanaf het beginstadium bij non-unions van minder dan 10 mm met stabiele osteosynthese.

Abstract beschikbaar op PubMed.gov.

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