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Bone Fractures - Treated by Ultrasound and Approved by NICE (UK)

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kahuna, Mar 29, 2013.

  1. Kahuna

    Kahuna Active Member

  2. Jvm620

    Jvm620 Member

    The osteopaths i work with say that it hurts & they always suspect a 'missed' fracture when treating an injury with ultrasound & the patient c/o pain during treatment.
  3. Kahuna

    Kahuna Active Member

    That's interesting - thanks very much for that
  4. David Wedemeyer

    David Wedemeyer Well-Known Member

    I can confirm that USD whether pulsed and especially applied constantly is very irritating to a fracture. It can be a fairly reliable diagnostic tool when an occult fracture is difficult to confirm on xray. I always found it somewhat fascinating that they were using it to heal fractures due to the discomfort that it can bring.
  5. Paul Bowles

    Paul Bowles Well-Known Member

    Internal and external bone simulators have been used for years to promote fracture healing.

    Apply high intensity pulsed or non pulsed clinical ultrasound to any bony prominance and it will produce discomfort - doesn't mean there is a fracture present. I can't recall any recent data showing it has any diagnostic properties at all. In fact why would you take the "guess" its a stress fracture and not just investigate further with radiology i.e. T99 bone scan or MRI?
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    Paul I don't think anyone is saying it is highly specific or the standard to diagnose any fracture but it does have some value. History (mechanism) and Exam should be the gold standard, imaging confirmatory.

    I've had patients arrive with negative films only to have a very uncomfortable USD session, be referred out for imaging and find a stress or occult fracture. It may be more anecdotal than perfect but....
  7. The Exogen Ultrasound Bone Stimulator has been used for about two decades for treating fractures here in the USA.

    I'm surprised it has taken this long for this technology to make it overseas.

  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    Got it now, this is why it is tolerated by fractures. A typical soft tissue treatment with USD is 1.0-1.5w/cm2.
  9. DrZetter

    DrZetter Member

    I've been using the Exogen US unit 2xdaily for nearly 6 weeks for a calcaneal sfx and it is never painful to use, however, I don't think it is doing anything increase healing.

    Re: the "slowness" to get overseas I have many practitioners look at me funny when I tell them I using US for a fracture. And I'm in the states.
  10. Lee

    Lee Active Member

    Hi Kevin,
    In short, it hasn't taken so long - it has just taken a while for national guidelines in the UK to recommend it. My personal experience of Exogen (and similar) is mixed. Personally, I do not think it is 'all that' when it comes to non-unions and as your famous compatriot Flavor Flav would say, I don't believe the hype! This is purely based on managing (other people's) 1st ray non-unions (<10 times).
    All the best,
  11. stickleyc

    stickleyc Active Member

    Just by chance, when I was a grad student at Fresno State in the late 90's, we started working with Exogen in our Athletic Training room through our team Ortho. We were using these units a lot on diagnosed stress fractures and some acute fractures and taking regular x-rays to qualitatively assess improvements. The parameters of the Exogen US wave are such that unlike the pain typically elicited by a normal clinical US treatment, I never saw a patient report feeling it. The other cool thing was that the US "head" of the unit screws into a holder that is normally held on the body by a velcro strap but in our acute fracture patients, the ortho started building the portal into their cast and we'd just screw the unit into the cast for every treatment and replace a plug in the cast when finished.

    I was a very inexperienced clinician at the time but for what its worth, our long time team ortho doc said he felt like there was a noticeable increase in healing rate from what his years of experience led him to expect for the fractures he saw.

    After my experience with these units, I figured they would become a big deal in the years after that but didn't seem to see them that much later in my clinical experience. I know at one point the original Exogen start-up company was bought by one of the big conglomerates.

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