Bone Healing
The Ultrasound treatment is still unusual and mechanism of action is still completely not understood. Bone healing needs energy and looks like by ultrasound it is possible to energise this process in all levels like cells and citocins... Our standard is two Guidelines released in 2010 and 2013. These Guidelines are written using low significance reference articles. Only names of scientists and dates of articles are mentioned in the Guidelines for that it extremely difficult to find the related article. These articles have small groups of patients and patients were treated not in UK. Even abstracts of articles with big groups of patient impossible to find. Here we can find low cost evidence of Exogen comparing with other types of non-union
treatment.
I was provided by list of all patients treated by Exogen from 2010 to 2012. We collected all details from notes of these
patients. We evaluated x-rays and compared result with our standard. 47 patients were treated by Low Intensity Pulse Ultrasound LIPUS in YG. We excluded from the Audit 6 patients due to impossibility to find notes or x-rays or there were no signs of delayed union or patient was younger than 16 years old.
Mean age of patients was 51-54 years. We found that 30% of all diagnoses were Hypertension or microcirculation or cardiovascular related problems in PMH. It is not surprising in 54 years old patient group but it is one of reason why we getting non-unions. 40% patients had significant co-morbidity. We recorded all medication which was used by the
patients. 60 % of these medicaments directly decrease bone healing and it confirmed by scientific articles. The overall union rate using Exogen is 40% and it is 40% lower than is written in our Standard. Other cases finally were treated by ORIF or there were not enough details to confirm that Exogen was beneficial for the treatment. Unfortunelly it was impossible to collect and to group some important details as Date of the start of Full Weight Bearing Date of Painless Weight Bearing, Date of Normal Daily Living, Date of Return To Work, Total fracture healing time, Price of Exogen treatment per person.
This is our Audit recommendations: Exogen is effective one of conservative types of non-union treatment and especially successful in tibia and ulna shaft non-union treatment. Patient and Consultant both should be patient. Bone healing time can be 6 month and it is normal for some patients. Exogen Data and Fitting Form should be improved. Every patient exposed to LIPUS treatment should be reviewed by the specialist interesting in bone healing and non-union treatment (consultant who sub-specialises in that). Cost evidence Audit for LIPUS should be induced. PMH and medication especially poly-pharmacy cases should be revised from the point of view adverse influence to bone healing.
treatment.
I was provided by list of all patients treated by Exogen from 2010 to 2012. We collected all details from notes of these
patients. We evaluated x-rays and compared result with our standard. 47 patients were treated by Low Intensity Pulse Ultrasound LIPUS in YG. We excluded from the Audit 6 patients due to impossibility to find notes or x-rays or there were no signs of delayed union or patient was younger than 16 years old.
Mean age of patients was 51-54 years. We found that 30% of all diagnoses were Hypertension or microcirculation or cardiovascular related problems in PMH. It is not surprising in 54 years old patient group but it is one of reason why we getting non-unions. 40% patients had significant co-morbidity. We recorded all medication which was used by the
patients. 60 % of these medicaments directly decrease bone healing and it confirmed by scientific articles. The overall union rate using Exogen is 40% and it is 40% lower than is written in our Standard. Other cases finally were treated by ORIF or there were not enough details to confirm that Exogen was beneficial for the treatment. Unfortunelly it was impossible to collect and to group some important details as Date of the start of Full Weight Bearing Date of Painless Weight Bearing, Date of Normal Daily Living, Date of Return To Work, Total fracture healing time, Price of Exogen treatment per person.
This is our Audit recommendations: Exogen is effective one of conservative types of non-union treatment and especially successful in tibia and ulna shaft non-union treatment. Patient and Consultant both should be patient. Bone healing time can be 6 month and it is normal for some patients. Exogen Data and Fitting Form should be improved. Every patient exposed to LIPUS treatment should be reviewed by the specialist interesting in bone healing and non-union treatment (consultant who sub-specialises in that). Cost evidence Audit for LIPUS should be induced. PMH and medication especially poly-pharmacy cases should be revised from the point of view adverse influence to bone healing.
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| petrisor_2009_article_extracorporeal_shock_wawe.docx |
| tobita_2011_article.pdf |
