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The Journal of Bone and Joint Surgery (American) 86:2275-2282 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Low-Intensity Transosseous Ultrasound Accelerates Osteotomy Healing in a Sheep Fracture Model

Michael E. Hantes, MD1, Alexandros N. Mavrodontidis, MD2, Charalampos G. Zalavras, MD3, Apostolos H. Karantanas, MD4, Theofilos Karachalios, MD1 and Konstantinos N. Malizos, MD1

1 Department of Orthopaedic Surgery, University Hospital of Larisa, Mezourlo 41110 Larisa, Greece. E-mail address for M.E. Hantes: hantesmi{at}otenet.gr
2 Department of Orthopaedic Surgery, University Hospital of Ioannina, 12 Meletiou-Geografou Street, PC45333 Ioannina, Greece
3 Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, LAC + USC Medical Center, 1200 North State Street, GNH 3900, Los Angeles, CA 90033
4 Department of Computed Tomography and Magnetic Resonance Imaging, Larisa General Hospital, 1 Tsakalof Street, 41221 Larisa, Greece

Investigation performed at the University Hospital of Ioannina, Ioannina, Greece

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Greek government, Ministry of Development: Department of Research and Technology. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Low-intensity transcutaneous ultrasound can accelerate and augment the fracture-healing process. The aim of this study was to investigate the effect of transosseous application of low-intensity ultrasound on fracture-healing in an animal model.

Methods: A midshaft osteotomy of the left tibia was performed in forty sheep. An external fixator was used to stabilize the osteotomy site. A thin stainless-steel pin was inserted into the bone, 1.0 cm proximal to the osteotomy site. Ultrasound was transmitted through the free end of this pin, with a PZT-4D transducer. In twenty animals, the treated limb received a 200-µsec burst of 1-MHz sine waves repeated at 1 kHz with an average intensity of 30 mW/cm2 for twenty minutes daily. Twenty other animals underwent the same surgery but did not receive the ultrasound (controls). Animals were killed at seventy-five and 120 days postoperatively. Radiographic evaluation was performed every fifteen days. Mechanical testing and quantitative computed tomography were performed after death.

Results: Fractures treated with ultrasound healed significantly more rapidly, as assessed radiographically, than did the controls (seventy-nine compared with 103 days, p = 0.027). On day 75, the mean cortical bone mineral density (and standard deviation) was 781 ± 52 mg/mL in the treated limbs compared with 543 ± 44 mg/mL in the control group (p = 0.014), and the average ultimate strength (as assessed with a lateral bending test) was 1928 ± 167 N in the treated limbs compared with 1493 ± 112 N in the control group (p = 0.012). No significant differences were noted on day 120.

Conclusions: This study demonstrated that low-intensity transosseous ultrasound can significantly accelerate the fracture-healing process, increase the cortical bone mineral density, and improve lateral bending strength of the healing fracture in a sheep osteotomy model.

Clinical Relevance: Transosseous application of low-intensity ultrasound at close proximity to the fracture site may enhance the mechanical properties of the fracture callus and reduce the time to fracture-healing. However, further investigation is needed to establish the safety and efficacy of the technique.


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