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Mirulla AI, Brogi C, Barone G, Secciani N, Sansom W, Bartalucci L, Ridolfi A, Allotta B, Bragonzoni L. External devices increasing bone quality in animals: A systematic review. Heliyon 2023; 9:e22379. [PMID: 38027551 PMCID: PMC10679491 DOI: 10.1016/j.heliyon.2023.e22379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/28/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Osteoporosis can reduce bone quality and increase the risk of fractures. In addition to pharmacological approaches, physical activity, and implanted devices, external devices can also be detected in the literature as a technique to strengthen bones. This type of intervention arises to be particularly promising because it minimizes the invasiveness of therapy. Methods: A systematic review of the technologies involved in such devices was carried out to identify the most fruitful ones in improving bone quality. This review, according to the PRISMA Statement, focuses on studies involving animals, and excludes pharmaceutical approaches. Findings: The animal models and devices used, their settings, interventions, outcomes measured, and consequent effect on bone quality are reported for each detected technology. Ultrasound and laser arose to be the most studied technologies in the literature, even if they have yet to be proved to have a significant effect on bone quality. Interpretation: External devices for bone quality improvement offer a non-invasive approach that causes minimum discomfort to the patient. This review aimed to detect which technologies reported in the literature significantly affect bone quality. The results showed that several technologies are currently used to improve bone quality. However, each study measures different outcomes and uses different measurement methods, device settings, and interventions. This lack of standardization and the reduced number of articles found do not allow for proper quantitative comparisons.
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Affiliation(s)
- Agostino Igor Mirulla
- Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921, Rimini, Italy
| | - Chiara Brogi
- Department of Industrial Engineering, University of Florence, Via di Santa Marta 3, 50139, Firenze, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921, Rimini, Italy
| | - Nicola Secciani
- Department of Industrial Engineering, University of Florence, Via di Santa Marta 3, 50139, Firenze, Italy
| | - William Sansom
- Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921, Rimini, Italy
| | - Lorenzo Bartalucci
- Department of Industrial Engineering, University of Florence, Via di Santa Marta 3, 50139, Firenze, Italy
| | - Alessandro Ridolfi
- Department of Industrial Engineering, University of Florence, Via di Santa Marta 3, 50139, Firenze, Italy
| | - Benedetto Allotta
- Department of Industrial Engineering, University of Florence, Via di Santa Marta 3, 50139, Firenze, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921, Rimini, Italy
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Brueton RN, Heatley FW, Brookes M. The effect of ultrasound on bone healing across a bone gap, an experimental study of a delayed union model. Injury 2023; 54:110820. [PMID: 37277267 DOI: 10.1016/j.injury.2023.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
The aim of the study is to determine whether ultrasound accelerates bone repair across a bone gap. To replicate the clinical situation of bone repair in a severe tibial fracture, such as Gustilo grade three, we designed an experimental model to determine whether ultrasound can promote bone healing in the presence of a bone gap. The effect of ultrasound on bone healing of a tibial bone gap held in an external fixator was studied. 60 New Zealand White rabbits were divided into four groups. In one group of 6 animals, a tibial osteotomy was closed or compressed and studied at six weeks (Comparative Group). In 3 groups of 18 animals each, a tibial bone gap was maintained and was untreated, treated with ultrasound or mock ultrasound (Control Group). The repair of the bone gaps was studied in 3 animals each at 2,4,6,8,10 and 12 weeks. Investigation was by histology, angiography, radiography and densitometry. Three of the 18 untreated group progressed to delayed union, compared with 4 in the ultrasound and 3 in the mock ultrasound group (Control Group). Statistical analysis showed no difference between the three groups. 5 of the 6 closed/compressed osteotomies (Comparative Group) united faster at 6 weeks. The healing pattern of the bone gap groups were similar. We recommend this as a delayed union model. We found no evidence that ultrasound accelerated bone healing, reduced the rate of delayed union or increased callus formation in this model of delayed union. This study simulates delayed union following a compound tibial fracture and has clinical relevance concerning treatment of a delay in union with ultrasound.
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An exploratory clinical trial for concentrated autologous bone marrow aspirate transplantation in the treatment of osteonecrosis of the femoral head. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:441-447. [PMID: 35103855 DOI: 10.1007/s00590-022-03201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study evaluated the efficacy and safety of a novel treatment for osteonecrosis, in which concentrated autologous bone marrow aspirate transplantation (CABMAT) is followed by low-intensity pulsed ultrasound (LIPUS) stimulation for 3 months. The study was designed as a prospective, uncontrolled, open-label phase II clinical study. METHODS This study included 16 cases of osteonecrosis of the femoral head (ONFH), including 26 hips. Patients were transplanted with concentrated bone marrow and periodically evaluated for infection and neoplasm development. Moreover, clinical and radiological examinations were conducted to confirm the treatment efficacy. RESULTS No infections were observed during the course of this study nor tumours developed at the treatment site 24 months after transplantation. At a mean 48 (30-56) months post-transplantation, the onset or progression of collapse was noted in four hips, of which one hip underwent total hip arthroplasty. CONCLUSION Treatment with CABMAT combined with 3-month LIPUS stimulation was safe, and further randomised clinical studies are needed to determine the efficacy and feasibility of this treatment. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000020940, 9/2/2016).
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Arima Y, Uemura N, Hashimoto Y, Baba S, Matsumoto N. Evaluation of bone regeneration by porous alpha-tricalcium phosphate/atelocollagen sponge composite in rat calvarial defects. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.odw.2012.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yoshiyuki Arima
- Department of Orthodontics, Graduate School of Dentistry, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Naoya Uemura
- Department of Oral Implantology, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan
| | - Yoshiya Hashimoto
- Department of Biomaterials, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan
| | - Naoyuki Matsumoto
- Department of Orthodontics, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
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Matsuse K, Hashimoto Y, Kakinoki S, Yamaoka T, Morita S. Periodontal regeneration induced by porous alpha-tricalcium phosphate with immobilized basic fibroblast growth factor in a canine model of 2-wall periodontal defects. Med Mol Morphol 2017; 51:48-56. [DOI: 10.1007/s00795-017-0172-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/18/2017] [Indexed: 01/27/2023]
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Bone regeneration with a collagen model polypeptides/α-tricalcium phosphate sponge in a canine tibia defect model. IMPLANT DENT 2016; 24:197-203. [PMID: 25734944 DOI: 10.1097/id.0000000000000210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We evaluated the effects of synthesized collagen model polypeptides consisting of a proline-hydroxyproline-glycine (poly(PHG)) sequence combined with porous alpha-tricalcium phosphate (α-TCP) particles on bone formation in a canine tibia defect model. MATERIALS AND METHODS The porous α-TCP particles were mixed with a poly(PHG) solution, and the obtained sponge was then cross-linked and characterized by x-ray diffraction and scanning electron microscopy. Tibia defects were analyzed in 12 healthy beagles using microcomputed tomography and histological evaluation. RESULTS At 2 and 4 weeks, the volume density of new bone was higher in the poly(PHG)/α-TCP group than in poly(PHG) alone group (P < 0.05); however, there was no difference at 8 weeks (P > 0.05). Histological evaluation at 4 weeks after implantation revealed that the poly(PHG) had degraded, and newly formed bone was present on the surface of the α-TCP particles. At 8 weeks, continuous cortical bone formation with a Haversian structure covered the top of the bone defects in both groups. CONCLUSION This study demonstrates that the composite created using porous α-TCP particles and poly(PHG) is sufficiently adaptable for treating bone defects.
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Peng M, Li Z, Hu H, Liu S, Xu B, Zhu W, Han Y, Xiong L, Lin Q. Pulmonary ground-glass nodules diagnosis: mean change rate of peak CT number as a discriminative factor of pathology during a follow-up. Br J Radiol 2015; 89:20150556. [PMID: 26562098 DOI: 10.1259/bjr.20150556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to analyse the peak CT number (PEAK) in CT number histogram of ground-glass nodules (GGN), meaning the most frequent density of pixels in the image of pulmonary nodule, based on three-dimensional (3D) reconstructive model pre-operatively, and the mean rate of PEAK change (V-PEAK) during a follow-up of GGN for differential diagnosis between pre-invasive adenocarcinoma (PIA) and invasive adenocarcinoma (IAC). METHODS CT number histogram of pixels in GGN was made automatically by 3D measurement software. Diameter, total volume, PEAK and V-PEAK were measured from CT data sets of different groups classified by pathology, subtype and number of GGN, respectively. RESULTS Among all 102 cases, 47 were PIA, including atypical adenomatous hyperplasia (n = 29) and adenocarcinoma in situ (n = 18), and 55 were IAC, including minimally IAC (MIA, n = 4). By Wilcoxon test, PEAK of IAC was significantly higher than that of PIA (p < 0.001). By receiver operating curve analysis, area under the curve (AUC) was 0.857 and threshold -820.50 Hounsfield units (HU) for differentiation between PIA and IAC. V-PEAK of IAC was unexpectedly remarkably smaller than that of PIA (p < 0.001) with AUC and threshold being 0.810 and -0.829 HU day(-1), respectively. CONCLUSION Pre-operative PEAK and V-PEAK, which interpret and evaluate the change of volume and density of pulmonary nodule simultaneously from both exterior and interior perspectives, can help to distinguish IAC from PIA. ADVANCES IN KNOWLEDGE This study provided researchers of GGN another perspective, taking both volume and density of nodules into consideration for pathological evaluation.
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Affiliation(s)
- Mingzheng Peng
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao Li
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyang Hu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sida Liu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binbin Xu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzhuo Zhu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yudong Han
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liwen Xiong
- 2 Department of Respiration, Shanghai Chest Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Lin
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bronoosh P, Tanideh N, Noorafshan A, Andisheh Tadbir A, Aalipanah M, Kamali F, Abbasnia K, Koohi-Hosseinabadi O. Effects of low-intensity pulsed ultrasound on healing of mandibular bone defects: an experimental study in rabbits. Int J Oral Maxillofac Surg 2015; 44:277-84. [DOI: 10.1016/j.ijom.2014.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/06/2014] [Accepted: 09/17/2014] [Indexed: 11/26/2022]
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Liu Y, Wei X, Kuang Y, Zheng Y, Gu X, Zhan H, Shi Y. Ultrasound treatment for accelerating fracture healing of the distal radius. A control study. Acta Cir Bras 2014; 29:765-70. [DOI: 10.1590/s0102-86502014001800012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022] Open
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Combined use of low-intensity pulsed ultrasound and rhBMP-2 to enhance bone formation in a rat model of critical size defect. J Orthop Trauma 2014; 28:605-11. [PMID: 24464096 PMCID: PMC4108582 DOI: 10.1097/bot.0000000000000067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone repair is regulated by biological factors and the local mechanical environment. We hypothesize that the combined use of low-intensity pulsed ultrasound (LIPUS) and recombinant human bone morphogenetic protein-2 (rhBMP-2) will synergistically or additively enhance bone regeneration in a model simulating the more difficult scenarios in orthopaedic traumatology. METHODS Femoral defects in rats were replaced with absorbable collagen sponges carrying rhBMP-2 (0, 1.2, 6, or 12 μg; n = 30). Each group was divided equally to receive daily treatment of either LIPUS or sham stimulation. At 4 weeks, new bone formation was assessed using quantitative (radiography and microcomputed tomography), qualitative (histology), and functional (biomechanical) end points. RESULTS LIPUS with 1.2 μg of rhBMP-2 significantly improved the radiographic healing as compared with its sham control starting as early as 2 weeks. Quantitatively, the use of LIPUS with 6 μg of rhBMP-2 significantly increased the bone volume. However, using LIPUS with 12 μg of rhBMP-2 indicated a reduction in callus size, without compromising the bone volume, which was also observable histologically, showing organized lamellar bone and repopulated marrow in the original defect region. Histologically, 1.2 μg of rhBMP-2 alone showed the presence of uncalcified cartilage in the defect, which was reduced with LIPUS treatment. Biomechanically, LIPUS treatment significantly increased the peak torsion and stiffness in the 6- and 12 μg rhBMP-2 groups. CONCLUSIONS LIPUS enhances rhBMP-2-induced bone formation at lower doses (1.2 and 6 μg) and callus maturation at 12-μg dose delivered on absorbable collagen sponge for bone repair in a rat critical-sized femoral segmental defect.
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Shimizu T, Takahata M, Kameda Y, Hamano H, Ito T, Kimura-Suda H, Todoh M, Tadano S, Iwasaki N. Vitamin K-dependent carboxylation of osteocalcin affects the efficacy of teriparatide (PTH(1-34)) for skeletal repair. Bone 2014; 64:95-101. [PMID: 24731926 DOI: 10.1016/j.bone.2014.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/16/2014] [Accepted: 04/04/2014] [Indexed: 01/02/2023]
Abstract
Teriparatide (PTH1-34) promotes skeletal repair and increases bone mass. Vitamin K is involved in bone mineralization as a coenzyme of γ-carboxylase for Gla proteins, and therefore vitamin K insufficiency caused by malnutrition or therapeutic intake of the vitamin K antagonist warfarin could affect the efficacy of PTH1-34 therapy for bone repair. In the present study, we investigated whether vitamin K influences the efficacy of PTH1-34 therapy for bone repair in a rat osteotomy model. Female 12-week-old Sprague-Dawley rats were subjected to a closed midshaft osteotomy of the femur and randomized into four groups (n=10 per group): vehicle, PTH1-34 (daily 30 μg/kg/day subcutaneous injection)+solvent (orally, three times a week), PTH1-34+warfarin (0.4 mg/kg/day orally, three times a week), and PTH1-34+vitamin K2 (menatetrenone, 30 mg/kg/day orally, three times a week). Serum γ-carboxylated and uncarboxylated osteocalcin (Gla-OC and Glu-OC) levels and radiographic healing were monitored every 2 weeks. Skeletal repair was assessed by micro-computed tomography, mechanical testing, and histology at 8weeks after surgery. PTH1-34 amplified the osteotomy-induced increase in Gla-OC and improved the mechanical properties as well as the volumetric bone mineral tissue density of the fracture callus. Concurrent use of warfarin decreased the response to PTH1-34 therapy in terms of mechanical recovery, probably by impairing mineralization due to the lack of Gla-OC. Although the effects of combination therapy with PTH1-34 and vitamin K2 on bone repair did not significantly exceed those of PTH1-34 monotherapy in rats fed sufficient dietary vitamin K, postoperative Gla-OC levels were correlated with the mechanical properties of the osteotomized femur in PTH1-34-treated rats regardless of the use of warfarin or vitamin K2. These findings suggest the importance of vitamin K dependent γ-carboxylation of OC for realizing the full effects of PTH1-34 on skeletal repair.
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Affiliation(s)
- Tomohiro Shimizu
- Hokkaido University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Japan
| | - Masahiko Takahata
- Hokkaido University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Japan.
| | - Yusuke Kameda
- Hokkaido University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Japan
| | - Hiroki Hamano
- Hokkaido University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Japan
| | - Teppei Ito
- Chitose Institute of Science of Technology, Chitose, Japan
| | | | - Masahiro Todoh
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Shigeru Tadano
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Hokkaido University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Japan
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Chen K, Hao J, Noritake K, Yamashita Y, Kuroda S, Kasugai S. Effects of low intensity pulsed ultrasound stimulation on bone regeneration in rat parietal bone defect model. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrm.2013.21002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tobita K, Matsumoto T, Ohashi S, Bessho M, Kaneko M, Ohnishi I. Effect of low-intensity pulsed ultrasound stimulation on gap healing in a rabbit osteotomy model evaluated by quantitative micro-computed tomography-based cross-sectional moment of inertia. J Orthop Sci 2012; 17:470-6. [PMID: 22543854 DOI: 10.1007/s00776-012-0233-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/11/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND It has been previously demonstrated that low-intensity pulsed ultrasound stimulation (LIPUS) enhances formation of the medullary canal and cortex in a gap-healing model of the tibia in rabbits, shortens the time required for remodeling, and enhances mineralization of the callus. In the current study, the mechanical integrity of these models was confirmed. In order to do this, the cross-sectional moment of inertia (CSMI) obtained from quantitative micro-computed tomography scans was calculated, and a comparison was made with a four-point bending test. METHODS This parameter can be analyzed in any direction, and three directions were selected in order to adopt an XYZ coordinate (X and Y for bending; Z for torsion). RESULTS The present results demonstrated that LIPUS improved earlier restoration of bending stiffness at the healing site. In addition, LIPUS was effective not only in the ultrasound-irradiated plane, but also in the other two planes. CONCLUSIONS CSMI may provide the structural as well as compositional determinants to assess fracture healing and would be very useful to replace the mechanical testing.
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Affiliation(s)
- Kenji Tobita
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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