Advertisement

Enhancing mechanical strength during early fracture healing via shockwave treatment: an animal study

  • Robert Wen-Wei Hsu
    Correspondence
    Corresponding author
    Affiliations
    Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, No. 6, West Section, Chia-Pu Road, Putz, Chia-yi, Taiwan, ROC
    Search for articles by this author
  • Ching-Lung Tai
    Affiliations
    Biomechanical Laboratory, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, No. 6, West Section, Chia-Pu Road, Putz, Chia-yi, Taiwan, ROC
    Search for articles by this author
  • Chris Yu-Chih Chen
    Affiliations
    Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, No. 6, West Section, Chia-Pu Road, Putz, Chia-yi, Taiwan, ROC
    Search for articles by this author
  • Wei-Hsiu Hsu
    Affiliations
    Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, No. 6, West Section, Chia-Pu Road, Putz, Chia-yi, Taiwan, ROC
    Search for articles by this author
  • Swei Hsueh
    Affiliations
    Department of Pathology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, No. 6, West Section, Chia-Pu Road, Putz, Chia-yi, Taiwan, ROC
    Search for articles by this author

      Abstract

      Objective. This investigation aims to determine (1) whether shockwave treatment helps fracture healing and (2) whether the effect of shockwave treatment on fracture healing is dose dependent.
      Design. Shockwave was applied over tibial osteotomy in an animal model to assess its effect on the healing of the fracture.
      Methodology. Bilateral tibial diaphyseal transverse osteotomy was conducted on 42 rabbits, dividing into experimental and control group, immobilized using an external skeletal fixator, with one leg tested with shockwave therapy and the contralateral leg acting as the control without therapy. Serial radiography and measurement of bone mineral density via dual-energy X-ray absorptiometry were performed to assess the fracture healing. The experimental animals had two or three sessions of shockwave therapy (5000 impulses, 0.32 mJ/mm2, Orthopedic™) over the osteotomy sites on day 7, 21 and 35; while the control group did not receive any treatment. The animals were sacrificed on day 42 or 56. Then, bilateral tibias were harvested and sent for mechanical tests as well as the histological examination. The pertinent statistic methods were applied to analyze the results.
      Background. Shockwave therapy has become a useful alternative approach in treating various orthopedic conditions, but the mechanism which it works remains unclear. Thus far, shockwave therapy has been found effective in treating long bone pseudoarthrosis, but whether it can benefit fresh fracture healing continues to be debated.
      Results. Higher union rates occurred during the early but not the late stages in the experimental group, while mechanical strength was higher in the experimental group than in the control group. No significant dose-dependent response occurred between the second and third applications of shockwave treatment. No significant difference in mechanical strength occurred between the experimental groups at 4 weeks and the control group at 6 weeks, or between the experimental groups at 6 and 8 weeks. Furthermore, no significant correlation occurred between the absolute values of maximum torque and bone mineral density.
      Conclusion. Based on this investigation, shockwave treatment has a positive effect on early fracture healing while its long term effects require further investigation.Relevance
      Shockwave therapy can be a useful alternative adjunct modality in the treatment of fresh long bone fracture.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bassett C.A.L.
        Current concepts on bone formation.
        J. Bone Joint Surg. 1962; 44A: 1217
        • Bassett C.A.L.
        • Herrmann I.
        Influence of oxygen concentration and mechanical factor on differentiation of connective tissue in vitro.
        Nature. 1961; 190: 460
        • Chaussy C.H.
        Extracorporeal shock wave lithotripsy.
        Karger. 1968; : 5-19
        • Chaussy C.H.
        • Brendel M.
        • Shmiedt E.
        Extracorporeally induced destruction of kidney stones by shock waves.
        Lancet. 1980; 2: 1265-1268
        • Dahmen G.P.
        • Meiss L.
        • Nam V.C.
        • Skrudies B.
        Extrakorporale StoBwellentherapie (ESWT) im knochennahen Weichteilbereich an der Schulter.
        Extracta Orthop. 1992; 15: 25-28
        • Delius M.
        • Draenert K.
        • Al Diek Y.
        • Dranert Y.
        Biological effects of shockwaves: in vivo effect of higher energy pulses on rabbit bone.
        Ultrasound Med. Biol. 1995; 21: 1219-1225
        • Eisenberger F.
        • Muller K.
        Urologische Steintherapie.
        Thieme, Stuttgart, New York1987 (pp. 26–30)
        • Forriol F.
        • Solchaga L.
        • Moreno J.L.
        • Canadel J.
        The effect of shockwaves on mature and healing cortical bone.
        Int. Orthop. 1994; 18: 325-329
        • Haberman
        Urologische Steintherapie.
        Thieme, Stuttgart, New York1987 (p. 30)
        • Haupt G.
        • Haupt A.
        • Ekkernkamp A.
        • Gerety B.
        • Chvapil
        Influence of shock waves on fracture healing.
        Endourology. 1992; 39: 529-532
        • Johannes E.J.
        • Dinesh M.K.S.
        • Matura E.
        High-energy shock waves for the treatment of nonunion: An experiment on dogs.
        J. Surg. Res. 1994; 57: 246-252
        • Krischek O.
        • Rompe J.D.
        • Herbsthofer B.
        • Nafe B.
        Symptomatic low-energy shockwave therapy in heel pain and radiologically detected plantar heel spur.
        Z. Orthop. Grenzgeb. 1998; 136: 169-174
        • Krischek O.
        • Haake M.
        • Jensen K.
        • Prinz H.
        • Willenberg T.
        Design of a multicenter study for assessing the effectiveness of extracorporeal shockwave therapy in epicondylitis humeri.
        Z. Orthop. Grenzgeb. 2000; 138: 99-103
        • Kusnierczak D.
        • Loew M.
        • Brocai D.R.
        • Vettel U.
        Effect of extracorporeal shockwave administration on biological behavior of bone cells in vitro.
        Z. Orthop. Grenzgeb. 2000; 138: 29-33
        • Loew M.
        • Jurgowski W.
        • Mau H.C.
        • Thomsen M.
        Treatment of the calcifying tendonitis of the rotator cuff by extracorporeal shock waves.
        J. Shoulder Elbow Surg. 1995; 4: 101-106
        • Loew M.
        • Daecke W.
        • Kusnierczak D.
        • Rahmanzadeh M.
        • Ewerbeck V.
        Shockwave therapy is effective for chronic calcifying tendinitis of the shoulder.
        J. Bone Joint Surg. 1999; 81: 863-867
        • Maier M.
        • Durr H.R.
        • Kohler S.
        • Staupendahl D.
        • Pfahler M.
        • Refior H.J.
        • Meier M.
        Analgesic effect of low energy extracorporal shockwaves in tendinosis calcarea, epicondulitis humeri radialis and plantar fascitis.
        Z. Orthop. Grenzgeb. 2000; 138: 34-38
        • Plaisier P.W.
        • van der Hul R.L.
        • Terpstra O.T.
        • Bruining H.A.
        Current role of extracorporeal shockwave therapy in surgery.
        J. Surg. [Br]. 1994; 81: 174-181
        • Rompe J.D.
        • Rumler F.
        • Hopf C.
        • Nafe B.
        • Heine J.
        Extracorporal shock wave therapy for calcifying tendinitis of the shoulder.
        Clin. Orthop. 1995; 321: 196-201
        • Rompe J.D.
        • Hopf C.
        • Nafe B.
        • Burger R.
        Low-energy extracorporal shockwave therapy for painful heel: a prospective controlled single-blind study.
        Arch. Orthop. Trauma Surg. 1996; 115: 75-79
        • Rompe J.D.
        • Kullmer K.
        • Riehle H.M.
        • Heine J.
        • Herbsthofer B.
        • Echardt A.
        • Burger R.
        • Nafe B.
        • Eysel P.
        Effectiveness of low energy shock wave for chronic plantar fasciitis.
        Foot Ankle Surg. 1996; 1: 215-221
        • Rompe J.D.
        • Hopf C.
        • Kullmer K.
        • Heine J.
        • Burger R.
        • Nafe B.
        Low-energy shockwave therapy (ESWT) for the persistent elbow epicondylitis.
        Int. Orthop. 1996; 20: 23-27
        • Rompe J.D.
        • Hopf C.
        • Kullmer K.
        • Heine J.
        • Burger R.
        Analgesic effect of extracorporal shock-wave therapy on chronic tennis elbow.
        J. Bone J. Surg. 1996; 78-B: 233-237
        • Rompe J.D.
        • Eysel P.
        • Hopf C.
        • Vogel J.
        • Kullmer K.
        Extracorporeal shockwave treatment of delayed bone healing. A critical assessment.
        Unfallshirurg. 1997; 100: 845-849
        • Rompe J.D.
        • Hopf C.
        • Vogel J.
        • Herbsthofer B.
        • Nafe B.
        • Burger R.
        Extracorporeal shockwave therapy in epicondylitis humeri ulnaris of radialis–a prospective, controlled, comparative study.
        Z. Orthop. Grenzgeb. 1998; 136: 3-7
        • Seemann O.
        • Rassweiler J.
        • Chvapil M.
        • Alken P.
        • Drach G.
        Effect of low-dose shock wave energy on fracture healing: an animal study.
        J. Endourol. 1992; 6: 219-223
        • Valchanou V.D.
        • Michailov P.
        High energy shock wave in the treatment of delayed and nonunion of fracture.
        Int. Orthop. 1991; 15: 181-184