Effects of pulsed ultrasound on fracture healing in long bones diaphyseal fractures with intramedullary implant

Abstract

Tibial shaft fractures are the most common conditions with the incidence of 16.9/100,000/year. The AO (Association of Orthopedic) type A1 fractures of tibia are the most common (34%) presentations. In spite of all recent advances these fractures are still challenging to choose the most appropriate treatment for faster recovery. Low Intensity Pulsed Ultrasound (LIPUS) of 1 MHz is used since 1950s in physiotherapy for treating bursitis and tendonitis. However, LIPUS effect on fracture healing and in delayed union is still controversial. Objective of this study was to find out effect of low intensity pulsed ultrasound (LIPUS) and Thera Tube exercises in shortening the healing time of fresh closed or Grade I open long bone fractures of lower limb when fixed with a reamed intramedullary nail (IMN) as it is a common impression that exercises specially resistance training helps in bone mineralization. An experimental study was conducted at government multi-specialty hospital on 60 skeletally mature male patients who had gone through IMN fixation for tibial shaft fractures. Subjects were divided into three groups through random sampling. The first group (control) was given conventional treatment with placebo, whereas second group (LIPUS) was treated with conventional as well as LIPUS therapy and third group (LIPUS + exercise) was treated with conventional, LIPUS therapy along with Thera band exercises. Data was collected for clinical assessment (VAS), radiographic evaluation (RUST score) and biochemical (serum ALP) analysis on regular intervals. After appropriate statistical analysis it was found that all the assessed three parameters (VAS, RUST and ALP) were not statistically significant upon univariant analysis, however, multivariate analysis statistically differentiate all the three groups in above assessed parameters. The healing was significantly faster in treatment group receiving LIPUS along with Thera tube exercises. It can be said that a good resistance exercise program using Thera band exercises along with conv