Ismiarto YD, Budi MNS, Mahyudin. Effectivity of Low Intensity Pulsed Ultrasound on Rabbit Femur Post Orif Plate and Screw. Biomed Pharmacol J 2020; 13(1).

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Manuscript received on :24 Dec 2019
Manuscript accepted on :31 Jan 2020
Published online on: 27-02-2020

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Plagiarism Check: Yes
Reviewed by: Neeraj Bokde  
Second Review by: Nicolas Padilla 
Final Approval by: Dr. Ian James Martin

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Ismiarto YD¹, Budi MNS² and Mahyudin³

¹Head of the Study Program of Department of Orthopaedics and Traumatology Faculty of Medicine Padjadjaran University dr. Hasan Sadikin General Hospital, Indonesia,

²Orthopaedic oncologist consultant of Orthopaedics and Traumatology Faculty of Medicine Padjadjaran University dr. Hasan Sadikin General Hospital, Indonesia

³Resident Department of Orthopaedics and Traumatology Faculty of Medicine Padjadjaran University dr. Hasan Sadikin General Hospital, Indonesia,

Corresponding Author E-mail : mahyudin307@gmail.com

DOI : https://dx.doi.org/10.13005/bpj/1910

Abstract

A femoral fracture is a trauma with a high mortality rate. Long bone fracture cases frequently related to missing bone segments, that can disrupt the bone healing. The process of defect fracture healing requires internal and external mechanical stimulation, external stimulation can be stimulated using low-intensity pulsed ultrasounds. Clinical studies have shown a significant positive effect from LIPUS in the treatment of non-union fractures and accelerated fracture repair compared to fractures treated with a placebo of 38%. The purpose of this study was to determine the effectiveness of LIPUS on the healing of defect femoral fractures in rabbit post-ORIF plate and screw-based on radiological measurements. This study is a comparative, unpaired laboratory experimental study with two treatment groups and one control group. The treatment group consists of group I that was given LIPUS 30 mW/cm2 for 10 minutes per day and Group II 30 mW/cm2 for 20 minutes per day, Group III without LIPUS treatment as the control group. Radiological assessment was performed to assess callus formation based on the Tiedemann score. After that data is collected, data editing, coding, entry were carried out and analyzed statistically. There were significant differences between treatment group and control group towards callus diameter formation, between-group I, II and control with mean of Tiedemann in each group 97.76; 169.83; 76.88; with p-value < 0.05. LIPUS can enhance fracture healing in rabbit femur defects based on radiography measurement.

Keywords

Fracture; Femur; Healing; Mechanical; LIPUS; Radiological

Introduction

A femoral fracture is a trauma with a high mortality rate. The incidence of femoral fractures in America is approximately 13 cases per 100,000 people per year.^1,2 In Indonesia, it is reported that the incidence of fractures every year is 11.10 cases per 1,000 people per year, with an incidence of 11.67 cases per 1,000 people per year in men and 10.65 cases per 1,000 people per year in women. In children and adults, femoral fracture events are associated with low energy mechanisms, whereas in the young adult the mechanism is high energy.^1-3 Long bone fractures are often accompanied by bone defects, this can interact with the healing process. If internal fixation is done to this fracture, then the defect will interrupt the healing process. The incidence of long bone fractures with defects is 13.9%.^4,5

Fracture healing is a complex process. Clinically, it is necessary to reduce and stabilize shifting fractures.⁴ The biological process of fracture healing consists of several different phases. This phase includes the inflammatory phase with cell proliferation, the chondrogenic phase with cartilage hypertrophy and angiogenesis, and the osteogenic phase with cartilage replacement with woven bone and remodeling.⁴ Fracture healing is influenced by external (biomechanical) and internal (biological) stimuli. Biological interventions such as the use of allogenic bone graft, substitute substances for a bone graft, medical, while external stimuli in the form of mechanical and physical interventions, such as static and dynamic methods for stabilization in operative actions, and the use of noninvasive actions such as electromagnetic and ultrasound.^6-8

Ultrasound is a source of mechanical energy delivered as acoustic pressure waves outside the range of human hearing.⁵ Ultrasound has a variety of medical applications, ranging from diagnostic tools to therapeutic agents.⁵ Usually, at low intensities (0.5-50 mW/cm²), ultrasound acts as a diagnostic modality, whereas at higher intensities (0.2-100 mW/cm²), ultrasound has a therapeutic effect by producing heat energy.⁵ Although preliminary studies have found high-intensity ultrasound (0.2-100 mW/cm²) inhibits bone healing, several recent studies studying low-intensity pulsed ultrasound (LIPUS) in the range of diagnostic intensity have shown more beneficial effects.^5,6

Clinical studies have shown a significant positive effect of LIPUS in the treatment of fracture cases that fail to connect.⁴ Other studies investigating the application of LIPUS in conservative tibia fractures and distal radius fractures both show a 38% acceleration in fracture repair. Gebauer reported an accelerated rate of fracture healing by 85% after 5 months, while Nolte et al reported the effect of LIPUS on accelerating fracture healing by 86% in an average time of 5.5 months^.6-10

Long bone fractures, especially the femur, are a fracture that needs peculiar treatment, so that the healing process of the bone is not disrupted which causes the bones to not attach. The bone healing process requires sufficient internal and external stimuli. External stimulation (biomechanics) can accelerate the fracture healing process, one of which is using low-intensity ultrasound. Low-Intensity Pulsed Ultrasound has been known to accelerate the fracture healing process. What is the role of Low-Intensity Pulsed Ultrasound as an alternative measure to the formation of hard callus in rabbit femur defects after ORIF plate and screw-based on radiographic measurements? In this study, we will examine the effects of ultrasound stimulation on hard callus formation in rabbit femur defects post ORIF plate and screw-based on radiographic measurements.

Materials and Methods

This study is an experimental laboratory test in animals with a simple randomized sampling method. The object of this study used subjects in the form of experimental animals, namely New Zealand white rabbits that met the inclusion criteria. Research samples in the case and control groups were taken by completely randomized design methods that met the inclusion and exclusion criteria. The sample size of experimental animals in this study was a minimum of 9 animals for each group based on the Federer formula. The addition may be done