Ultrasound shockwave therapy to heal fractures

Scientists have developed a new, non-invasive treatment using ultrasound shockwaves that can heal broken bones without under going surgery.

In most cases, fractures heal naturally, usually with the help of a splint or cast to keep the bone in place, over a period of weeks or months.

However in around five percent of fractures, a gap remains between the two broken ends, usually a result of damage to the blood supply to the bones or infection .

These are called non-union fractures. In order for healing to occur, the gap needs to be filled in.

Previously the only option was a bone graft. More recently a man-made version of a growth factor called bone morphogenetic protein has been used.

But now orthopaedic surgeons are using pulsed ultrasound to heal these stubborn fractures.

The Exogen Ultrasound Bone Healing System is a battery-powered device roughly the size of a mobile phone that emits low intensity soundwaves through the skin to the fracture. These pulses stimulate the bone to heal.

"The ultrasound creates minute vibrations. This causes the bones to produce their own version of bone morphogenetic protein. It's like switching on a light and waking up the damaged edges of the fracture," the quoted Mark Phillips , senior orthopaedic consultant at King's College, London , as saying.

The device must be used for 20 minutes each day by the patient at home and it takes around six weeks until results can be seen on X-rays. The treatment is painless and has no known side effects.

Clinical studies have put Exogen's success rate at 86 per cent although Phillips says it is not a miracle cure for everyone.

"There are limitations. Any gap larger than half an inch will usually require surgical intervention," he said.

Shockwave Therapy - Newsletters

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Many of us have heard the term shockwave therapy, some of us have used shockwave therapy to treat injuries in our horses, but how much do we really know about the principles behind this innovative treatment?

First, what exactly is a shockwave? A shockwave is a pressure wave, a high frequency sound wave. Any action that displaces its surrounding medium is a shockwave. The ripple in the water created when a rock is thrown into a pond is a shockwave. An earthquake is a shockwave in the earth.

The shockwaves used in veterinary medicine can be generated in three different ways: electrohydraulically, piezoelectrically or through an electromagnetic field. Shockwaves are focused, and can be directed to the precise area of the injury. They are transmitted readily from the transducer head, through ultrasound coupling gel, and through soft tissue where the energy of the wave is released at a specific depth, depending on the transducer head that is used.

With that knowledge, what do shockwaves do that is therapeutic? Shockwave therapy is involved in the healing process on many levels and has a role in a myriad of different metabolic processes important in healing. Shockwave therapy has been shown to stimulate new bone growth in fractures, stimulate the in-growth of new blood vessels (neovascularization), increase cell permeability and possibly stimulate fibroblast formation (the cells important in repairing tendons and ligaments).

In addition, shockwave therapy stimulates stem cells that occur naturally in the animal’s body to migrate to the area that is treated. It has a potent anti-inflammatory effect and has also been found to have anti-bacterial capabilities. Shockwave therapy has a transient analgesic effect as well.

Used extensively in Europe, Asia, and South America to treat a wide variety of soft tissue and orthopedic injuries in people, it is the treatment of choice in many areas of the world for non-union fractures. It is also very effective at treating chronic, infected wounds that have not responded to traditional therapies. It has been approved in the U.S. by the FDA for selected conditions.

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