The Effect Of Using Extracorporeal Shock Waves In Bone And Limb Lengthening Using The OrthoFix Fixator

Me: This study I found showed what would happen if we tried to use the extracorporeal shockwave therapy when we are doing the regular type of bone lengthening through distraction osteogenesis. Of course this is not for height increase application but to see what would be the effect on callus formation. Remember that distraction osteogenesis works on the principle of callus stretching.

Analysis: What we see is a testing on 25 rabbits on the effect of the shockwaves on bone stretching. the Orthofix bone fixator is used, which is a device I have looked at before. The shockwaves wre done 3 weeks after the limb lengthening surgery. The dosage was 0.42 mJ/mm^2 intensity at a pulse frequency of 2 Hz (2 times a second). 3000 pulses were done.

Bad News: “Radiographs and histological observations revealed no apparent fractures in nonlengthening tibias at the shock wave energy densities used.” this seems to suggest that if we are trying to just use the ESWT technology to apply it on non distracted long bones, it can’t work to lengthen it since it can’t even make a few fractures.

Other News: X-Rays showed no difference between the ESW applied group and the control group. However the bone mineral density from dual energy absorptiometry analysis showed that it was significantly increased in the ESW applied group. About 6 months in, both groups saw the bone mineral density decrease. It seems that the ESW might have had an inhibitory affect on the development of the cortex but have a stimulating effect on the inner cancellous or trabecular bone material.

Conclusion: This study seems to suggest that when you use the ESW technology with limb lenghtening surgery, it doesn’t seem to help the distraction healing and closure process increase. There was little effect seen.


From PubMed study link HERE

J Orthop Sci. 2003;8(4):474-81.

Effect of extracorporeal shock waves on callus formation during bone lengthening.

Narasaki K, Shimizu H, Beppu M, Aoki H, Takagi M, Takashi M.

Source

Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-0015, Japan.

Abstract

The effects of extracorporeal shock waves (ESWs) on callus formation during bone lengthening were studied in 25 female Japanese white rabbits. Bone lengthening of 9.8 mm was obtained over 2 weeks using the Orthofix M-100 bone fixator. ESWs were applied 3 weeks after surgery. Pins were removed 7 weeks after surgery, and specimens were prepared after the animals were killed at 9 and 24 weeks. The shock wave setting used was 0.42 mJ/mm(2) with a pulse interval of 2 Hz; 3000 shots each were applied to the central and peripheral areas. The specimens were evaluated using radiography, bone mineral density (BMD) measured by dual energy absorptiometry (DXA), and a three-point bending test to evaluate mechanical strength. Histological examination was performed on the lengthened portion. Radiographs and histological observations revealed no apparent fractures in nonlengthening tibias at the shock wave energy densities used. Radiographic observations revealed no apparent differences between the control group and the ESW group. BMD measurements by DXA revealed significantly increased bone mass in the ESW group 9 weeks after surgery. At 24 weeks after surgery the mean BMD had decreased to 25% and 15% of the values at 9 weeks in the control and ESW groups, respectively. The three-point bending test revealed no significant differences between the groups. Histological observations revealed significant capillary formation and osteoblasts and chondrocytes in the bone marrow as well as bridging of newly formed trabeculae 2 weeks after the bone was lengthened. At 4 weeks after treatment, observations included parts of the lengthened portion with no cortex or immature bone. At 9 weeks after surgery, cortex formation and a normal medullary cavity were clearly observed in the control group, whereas observations in the treated group included areas of the lengthened portion with no cortex and formation of immature trabecular structures and increased cancellous bone in the center of the lengthened portion. At 24 weeks after surgery, more prominent cortex formation and fatty marrow were observed in the ESW group than in the control group.

PMID: 12898297    [PubMed – indexed for MEDLINE]

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