Keeping you up-to-date on recent developments in orthopedics.
Shock-wave therapy for unhealed fractured bones as effective as surgery .... When fractured bones fail to heal, a serious complication referred to as "nonunion" can develop. This occurs when the process of bone healing is interrupted or stalled. According to a new study published in the November 2009 issue of the Journal of Bone and Joint Surgery, certain cases involving nonunions respond very well to shock-wave therapy. Researchers say this non-invasive treatment is equally effective as surgery when it comes to healing the bone. "We found that extracorporeal (external to body) shock-wave therapy was just as effective as surgery in helping to heal and repair nonunions," said lead author of the study Angelo Cacchio, MD, a physiatrist who conducted the study with colleagues from the Division of Orthopaedic Surgery and the Department of Physical Medicine and Rehabilitation at San Salvatore Hospital (L'Aquila, Italy). Study authors say sparse surrounding vascular tissue and limited blood supply can lead to a nonunion and can subsequently delay or prevent healing. This complication — a nonunion — often is very difficult to treat. Cacchio and his colleagues analyzed data from 126 patients who had nonunions of the femur (thigh bone), tibia (shinbone), ulna (forearm) or radius (forearm). Patients were randomly assigned to one of three groups and all patient outcomes were evaluated from 2001 to 2004. The patients in the three groups had similar demographic characteristics and similarly timed and developed nonunions. The first two groups of patients received surgery to help repair their fracture. The third received four shock-wave therapy sessions at weekly intervals, with 4000 impulses per session. The study found that shock-wave therapy: Stimulated healing of the bone within six months; and provided a comparable outcome to surgery even two years following the treatment. "When we examined patients and compared their outcomes at three and six months, initially those who received the shock-wave therapy actually felt better than those who had surgery," said Cacchio. "When we examined patients at 12 and 24 months there were no significant differences in terms of healing. Scans of the bones proved non-invasive shock-wave therapy worked just as effectively as surgery." Results of the study showed that nonunions had completely healed for approximately 70% of all patients within six months.
Improved healing of bone fractures after radiation exposure ... A drug currently under development by the University of Pittsburgh School of Medicine may help bone fractures heal more quickly after radiation exposure, according to a study by Pitt researchers. The study's results were presented during the American Society for Radiation Oncology (ASTRO; Fairfax, Virginia) annual meeting in Chicago. The drug, JP4-039, is a free-radical scavenger targeted to the mitochondria, the energy generator of all cells. For this study, researchers compared the healing time of fractures in a mouse model system treated immediately after radiation exposure with JP4-039 against a control group of mice that did not receive the drug. The fractured bones in the group treated with JP4-039 healed much more rapidly than the control group. "This study has important implications on two levels," said study author Abhay Gokhale, MD, chief resident in the Department of Radiation Oncology. "From a patient care standpoint, this drug could eventually be beneficial to pediatric cancer patients who are vulnerable to the late effects of radiation treatment on bone growth and development. From an emergency response perspective, if the ideal dosage of the drug is developed and we find a way to have it easily administered, it could potentially help people exposed to radiation in an accident or attack." This project has been funded in whole or in part with federal funds from the Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, under Contract No. HHSO100200800062C.
Aggressive osteoporosis prevention could see nation's hip fracture rate drop 25% ... Aggressively managing patients at risk for osteoporosis could reduce the hip fracture rate in the United States by 25%, according to a Kaiser Permanente study published in the November issue of the Journal of Bone & Joint Surgery. The first step must be a more active role by orthopedic surgeons in osteoporosis disease management, researchers say. This study, the largest to look at osteoporosis management in men and women over 50 years old, followed 650,000 men and women in Kaiser Permanente's osteoporosis management program and found hip fractures dropped by 38%, preventing 970 hip fractures in 2007. The prospective observational study examined the effectiveness of the Kaiser Permanente Southern California's Healthy Bones Program from 2002 to 2007. Kaiser Permanente HealthConnect, the world's largest civilian electronic health record database, was used to collect data on patients that included anti-osteoporosis medication usage, bone density scans and fragility fractures. "Currently in the United States, the rate of treatment after a fragility fracture is only 20 percent. Treatment after a fragility fracture at Kaiser Permanente in Southern California is now 68 percent. Health care would be drastically improved if this model of osteoporosis care were adapted for the rest of America," said the study's lead author Richard M. Dell, MD, an orthopedic surgeon at Kaiser Permanente in Downey, California. The Healthy Bones Program aggressively targets people at risk for hip fractures by identifying them through KP HealthConnect to ensure they get the bone density screenings and medications they need. The multidisciplinary team includes orthopedic surgeons and providers from endocrinology, family practice, internal medicine, rheumatology, gynecology, physical therapy, disease/care management, radiology, and nursing education. In this study, researchers found that annual bone density screening rates increased by 263% from 2002 to 2007. In 2002 there were 21,557 scans a year. In 2007, there were 78,262 scans. The number of people on anti-osteoporosis medications increased by 153% from 33,208 in 2002 to 84,155 a year in 2007. "The most important thing an orthopedic surgeon should know about osteoporosis/fracture prevention is that we can take action that helps to prevent hip and other fragility fractures," Dell said. "Simple steps like suggesting calcium and vitamin D for all your patients and bone mineral density testing in patients at higher risk for osteoporosis should be considered part of your daily practice." More than 300,000 hip fractures are reported annually in the U.S. Twenty-four percent of people who experience a hip fracture end up in a nursing home, 50% never reach their functional capacity, and 25% of patients over 65 years of age with a hip fracture die in the first year after the incident.
Laser Spine Institute buys non surgical spine therapy company ... After helping thousands of patients get their lives back through minimally invasive endoscopic spinal surgery at facilities in Tampa and Scottsdale and soon Philadelphia, the Laser Spine Institute (LSI; Tampa, Florida) reported that it has acquired Aspen Back & Body (ABB; Aspen, Colorado), extending LSI's patient care capabilities into non-surgical areas for the first time. ABB is a nationally branded destination provider of innovative therapies, blending spine fitness and wellness to prevent and relieve back and neck pain. Situated in the St. Regis Hotel in Aspen, Colorado, ABB offers clients extraordinary one- to three-week "spine fitness" programs encompassing three to four hours a day of personalized therapy. All sessions are overseen by a doctor of physical therapy with the goal of improving spine-related muscle strength, flexibility, alignment and general wellness. These programs include strength training, Gyrotonic flexibility sessions, vibration training, water therapy and pilates, as well as education sessions, signature massage and healthy meals. "With this acquisition, LSI can now provide patients a full range of highly effective, non-surgical treatments, complementary with existing surgical services," said LSI chief development officer Trey Traviesa. "This will allow LSI to care for our patients across the cycle of spinal care whether patients seek maximum pre-surgical relief or continued support for post-surgical results," said LSI founder and chief surgeon Dr. James St. Louis.
— Compiled by Holland Johnson, MDD