Authors: (including presenting author): :
Tai WK, Wong KTE, Lam SLR, Wong SW
Affiliation: :
Physiotherapy Department, United Christian Hospital
Introduction: :
Non-union or delayed union is a common complication for patients suffered from fracture. Patients usually result in persisted pain, functional loss and difficulty in return to work which cause detrimental effect on their quality of life. Also, many of these patients need subsequent surgery for achieving bone healing. It extends the suffer of patient and increase the labor cost of hospital for the surgery. Low Intensity Pulsed Ultrasound (LIPUS) is one of the non-invasive alternatives to surgery and has been demonstrated promising result on promoting bone healing in non-union in various randomized controlled trials and meta-analysis. Because of the strong clinical evidence, BOOST service through application of LIPUS has been introduced in Physiotherapy Department of United Christian Hospital in January 2020. Outcomes of BOOST service were collected to evaluate the effectiveness of LIPUS and establish evidence-based practice.
Objectives: :
1)To evaluate the effectiveness of LIPUS on bone healing 2)To demonstrate BOOST service is an effective non-surgical alternative for patients suffering from non-union or delayed union
Methodology: :
One group pre-test post-test study design was employed. The LIPUS machine used is Osteotron IV and the protocol was: Intensity at 30mW/cm2, repetition rate at 1.0kHz, frequency at 1.5MHz, 20 minutes, 3-5 sessions per week and terminate criteria is when solid union or maximum attendances of 120 achieved. Patient inclusion criteria were fracture non-union or delayed union with prior-without-surgery-interval (PWSI) more than or equal to 2 months and 3 months for upper limb fracture and lower limb fracture respectively. PWSI is set to avoid bias from contribution of the recent surgery and natural healing to the outcomes. Outcomes were the heal rate and time for achieved radiographic bone consolidation.
Result & Outcome: :
From Jan 2020 to Feb 2021, 22 patients were served in BOOST service. Average number of weeks to start LIPUS is 18.1 weeks post-injury or post-operation. 72.7% of patients achieved bone consolidation. Averaged time of achieved radiographic bone consolidation after application of LIPUS is 16.4 weeks and 11.2 weeks for upper limb and lower limb fracture respectively.
In conclusion, LIPUS demonstrated promising results in facilitating bone growth in nonunion patients. BOOST service provides an effective non-invasive alternative for patient and potentially reduced the labor cost of hospital by avoiding surgery for non-union patients.
