Abstract
Introduction: In 1995 we started using, at the G. Pini Orthopaedic Istitute of Milano, a system for bone healing stimulation based on low intensity pulsed ultrasound. Advantages of the method are: home therapy (20 minutes per day); no side effects, even in the presence of metallic devices or infection; ease of use. Indications of low intensità pulsed ultrasound are bone healing after fresh frarctures, in which a significant bone healing accelation can be observed, delayed and non-unions. We share our experience in a challenging field of application: septic non-unions.
Materials and methods: We retrospectively evaluated 30 patients, treated from 1996 to 2003, affected by septic non-unions (a fracture that, in the presence of infection, did not show any significant increase in callus formation at 8 months from the time of fracture). The patients had a mean 1.7 ± 2 previous failed intervention. Patients were treated, in the absence of other medical or surgical treatment (excluding antibiotic therapy), with low intensity pulsed ultrasound (EXOGEN S.A.F.H.S. or, since year 2002, IGEA F.A.S.T.). The treatment was applied, after the necessary instructions, directly from the patient, at home, 20 minutes per day. Failures of the treatment were considered need for further surgery to stimulate bone healing, persistence of non-union at follow-up. Exclusion criteria included: evident instability of the synthesis, soft tissue loss and bone exposure, wide bone loss (> 2 cm).
Results: 24 bone healing (86 %), 4 failures (need for surgery), 2 treatment discontinuation. Mean treatment duration: 123 ± 43 days (minimum 90, maximum 240 days). No side effects local or general were observed. In 18 cases a bone debridment and/or hardware removal intervention had been performed after bone healing. At follow-up, 28 patients are free from infection, while two showed infection recurrence.
Conclusions: Low intensity pulsed ultrasound is an effective options in the treatment of septic non-unions, without side effects. An accurate indication and patient selection provide an advantageous cost/benefit ratio.
The abstracts were prepared by editorial secretary, Mrs K. Papastefanou. Correspondence should be addressed to Professor K.N. Malizos, Department of Orthopaedic Surgery, School of Medicine, University of Thessalia, Larissa, 41222 GREECE
