Atrophic pseudoarthrosis. Effect of application of extracorporeal shock waves in an experimental model in tibia of rabbits.
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Nov 13, 2017
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Abstract
IntroductionThe effects of extracorporeal shock wave therapy (ESWT) have been investigated in: human osteoblasts, fracture foci, non union and periosteum cells. The best results of non union treatment with ESWT have been documented for hypertrophic type. The objective of this study is to investigate the effects of ESWT in an atrophic non union focus generated in a rabbit tibia model.MethodsThree groups were included: a) Group A: fractures receiving extracorporeal shock wave therapy (ESWT); b) Group B: (“control”): fractures not receiving ESWT; c) Group C: no fractures (right leg). Staining with hematoxylin-eosin was performed. ESWT included one session of 2000 extracorporeal shock wave impacts at 10 kV. A biomechanical analysis with a 3-point loading system was performed. Eighteen samples were included in the biomechanical study, 7 in Group A, 3 in Group B and 8 in group C. The samples were placed between two 19 mm cylindrical supports which were 75 mm apart, oriented concentrically to the compression punch.ResultsThe histological test evidenced signs of union - periosteal and endosteal fracture callus - which were considerably larger in the tibias in Group A (treated with extracorporeal shock wave therapy) as compared to the control group (Group B). The maximum load for the healthy tibia Group (Group C) was higher as compared to Groups A (p<0.001; t:7.988) and B (p<0.001; t:6.599).ConclusionThis report shows a significant radiographic and histological changes after focus intervention with application of ESWT.
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del Vecchio, J. J., Galli Serra, M., Martínez Gallino, R., Guyot, J. P., Piazza, D. A., Raimondi, N., Caloia, M., Santini Araujo, E., & Autorino, C. M. (2017). Atrophic pseudoarthrosis. Effect of application of extracorporeal shock waves in an experimental model in tibia of rabbits. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(4), 321-326. https://doi.org/10.15417/706
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Basic Research
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14. Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res. 2001;(387):95-101.
15. BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) Study Group, Govender S, Csimma C, Genant HK, Valentin-Opran A. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am. 2002;84-A (12):2123-34.
16. Kuo SJ, Su IC, Wang CJ, Ko JY (2015) Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures. Int J Surg. 2015 Dec;24(Pt B):131-4.
17. Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM. Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1. J Bone Joint Surg Br. 2002; 84(3):457-61.
18. Forriol F, Solchaga L, Moreno JL, Canadell J. The effect of shockwaves on mature and healing cortical bone. Int Orthop. 1994;18(5):325-9.
19. Brownlow HC, Simpson AH. Metabolic activity of a new atrophic nonunion model in rabbits. J Orthop Res. 2000;18(3):438-42.
20. Santavirta S, Konttinen YT, Nordstrom D, Makela A, Sorsa T, Hukkanen M, Rokkanen P. Immunologic studies of nonunited fractures. Acta Orthop Scand. 1992;63(6):579-86.
2. Reed AA, Joyner CJ, Isefuku S, Brownlow HC, Simpson AH. Vascularity in a new model of atrophic nonunion. J Bone Joint Surg Br. 2003;85(4):604-10.
3. Brownlow HC, Reed A, Simpson AH. The vascularity of atrophic non-unions. Injury. 2002;33(2):145-50.
4. Brownlow HC, Reed A, Simpson AH. Growth factor expression during the development of atrophic non-union. Injury. 2001;32(7):519-24.
5. Harrison LJ, Cunningham JL, Stromberg L, Goodship AE. Controlled induction of a pseudarthrosis: a study using a rodent model. J Orthop Trauma. 2003;17(1):11-21.
6. Zucman J, Piketty D. Experimental study of the effect of bone marrow, periosteum and bone grafts in recent severe diaphysial fractures. Rev Chir Orthop Reparatrice Appar Mot. 1970;56(1):3-21
7. Ilarramendi A, Pascual Garrido C, De Carli P, Santini Araujo MG. Modelo experimental de seudoartrosis en roedores. Estudio biológico de su fisiopatología. Rev Asoc Argent Ortop Traumatol. 2005;70(1):63-67.
8. Martini L, Giavaresi G, Fini M, Torricelli P, de Pretto M, Schaden W, Giardino R. Effect of extracorporeal shock wave therapy on osteoblastlike cells. Clin Orthop Relat Res. 2003;(413):269-80.
9. Wang CJ, Yang KD, Wang FS, Hsu CC, Chen HH. Shock wave treatment shows dose-dependent enhancement of bone mass and bone strength after fracture of the femur. Bone. 2004;34(1):225-30.
10. Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res. 2001;(387):95-101.
11. Tam KF, Cheung WH, Lee KM, Qin L, Leung KS. Delayed stimulatory effect of low-intensity shockwaves on human periosteal cells. Clin Orthop Relat Res. 2005; 438:260-5.
12. Haffner N, Antonic V, Smolen D, Slezak P, Schaden W, Mittermayr R, Stojadinovic A. (2016) Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury. Jul;47(7):1506-13.
13. Rompe JD, Rosendahl T, Schollner C, Theis C. High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop Relat Res. 2001;(387):102-11.
14. Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res. 2001;(387):95-101.
15. BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) Study Group, Govender S, Csimma C, Genant HK, Valentin-Opran A. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am. 2002;84-A (12):2123-34.
16. Kuo SJ, Su IC, Wang CJ, Ko JY (2015) Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures. Int J Surg. 2015 Dec;24(Pt B):131-4.
17. Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM. Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1. J Bone Joint Surg Br. 2002; 84(3):457-61.
18. Forriol F, Solchaga L, Moreno JL, Canadell J. The effect of shockwaves on mature and healing cortical bone. Int Orthop. 1994;18(5):325-9.
19. Brownlow HC, Simpson AH. Metabolic activity of a new atrophic nonunion model in rabbits. J Orthop Res. 2000;18(3):438-42.
20. Santavirta S, Konttinen YT, Nordstrom D, Makela A, Sorsa T, Hukkanen M, Rokkanen P. Immunologic studies of nonunited fractures. Acta Orthop Scand. 1992;63(6):579-86.