Application of Local Vibrations in Delayed and Nonunion
Application of Local Vibrations in Delayed and Non-union Fractures: a Case Study 1, 2 1 3 C. Trombetta Eng MA Ph. D , P. Abundo Eng MA , A. Civitella MD , 1 N. Rosato FP and C. Foti MD FP 3 1 2 3 Medical Engineering Service, Fondazione Policlinico Tor Vergata, Rome Ph. D student in Advanced Technology in Rehabilitation Medicine, Tor Vergata University, Rome Tor Vergata University, Physical and Rehabilitation Medicine, Public Health Department, Rome
Vibration Energy in Orthopaedic Disabilities Local Vibrations and Bone Regeneration: Case Study Aim: Assess efficacy of Local Vibrations (LV) in delayed-union and non-union fractures through therapeutic vibration exercise by analysing radiographic appereance Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Mechanical Factors vs Body Response Mechanical factors hold an important role in human body adaptive response, as vibrations: ü improve muscular functions ü increase bone regeneration process by stimulating the muscle ü increase remineralization activity by triggering osteoblasts Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Vibration Exercise Whole Body Vibrations (WBV) Upper Arm Vibrations (UAV) Local Vibrations (LV) Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Why Local Vibrations? Clinical necessity: focus effects of treatment ü to strengthen the muscle after peripheral nervous system lesions or myo-osteo-articular lesions ü to reinforce muscle and minimize muscle hypotrophy after orthopedic surgery Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Why Local Vibrations? Clinical necessity: focus effects of treatment ü to improve muscle distensibility in joint recovery, in posture changes caused by retraction myo-tendon and in muscle lesions ü to amplify the proprioceptive afferents in balance alterations and proprioceptive recovery after orthopedic lesions Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Why Local Vibrations? Clinical necessity: focus effects of treatment on specific body segments ü Body is a system with n-degrees of freedom, every segment has its own resonance frequency ü Vibration effects depend on frequency, time and level of exposure Solution: LV Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Design of a Specific Device dedicated to LV application for bone regeneration and muscle strength ü allow the operator to increase the strain applied on the subject in relation to different applications ü comparable geometry with limb ü protect the operator from vibratory stress Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Design of a Specific Device dedicated to LV application for bone regeneration and muscle strength Medical Engineering and Rehabilitation Medicine Department at the Tor Vergata University in collaboration with the company Boscosystemlab Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Non-union and Delayed-union Fractures Failure of a fractured bone to heal normally ü Non-union: cessation of all reparative processes of healing without bone union ü Delayed-union: prolongation of time to fracture union Young Researchers Meeting Rome, 9 th February 2010
Vibration Energy in Orthopaedic Disabilities Non-union and Delayed-union Fractures Differentiation between delayed union and non union is often based on radiographic criteria and time Failure to show any progressive change in the radiographic appearance is evidence of non-union The changes in radiographic appearance may be slight radiographs should be scrutinized monthly Young Researchers Meeting Rome, 9 th February 2010
Case Study Ø Male patient presenting right tibia fracture Anamnesis 2004 Right tibia decomposed fragmented fracture which demanded reduction and fixation with plates and screws and metal cerclage 2008 Right leg TC showed redundant callus with no consolidation and reduced bone density: non-union fracture diagnosis Characteristics age 51 sex male weight 108 kg height 185 cm Young Researchers Meeting Rome, 9 th February 2010
Case Study Ø Monthly program was scheduled consisting in: ü daily treatments of 6 series of 5 repetitions at 35 Hz ü 30’’ time application for each repetition ü 1’ pause between repetitions ü 1’ 30’’ pause between series ü Application on the heel Young Researchers Meeting Rome, 9 th February 2010
Case Study Ø Since the early applications: ü a reduction of perilesion edema was shown ü the algic symptomatology improved ü improvements in paresthetic symptomatology Young Researchers Meeting Rome, 9 th February 2010
Case Study Ø Clinical results: ü independent ambulation ü disappearance of perimalleolar edema Cirtometria AAII Entrance Discharge Right leg Left leg Peri-malleolar 29. 5 cm 27 cm 28. 5 cm 27 cm 5 cm over medial malleolus 28. 5 cm 24 cm 28 cm 24 cm 10 cm over medial malleolus 29. 5 cm 25. 5 cm 28. 5 cm 25. 5 cm Scales Entrance Discharge LEFS 31/80 46/80 BARTHEL INDEX 98/100 100/100 Mc. Gi. LL PAIN QUEST. 25/60 10/60 Young Researchers Meeting Rome, 9 th February 2010
Case Study Ø Radiographic appearance: ü presence of bone repair activity around the fracture line Entrance Young Researchers Meeting Rome Discharge Follow-up Rome, 9 th February 2010
Case Study Ø Radiographic appearance: ü presence of bone repair activity around the fracture line Entrance Young Researchers Meeting Rome Discharge Follow-up Rome, 9 th February 2010
Thank you Chiara Trombetta chiara. trombetta@yahoo. it Paolo Abundo paolo. abundo@yahoo. it
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