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Saito K, Toyoda H, Okada M, Oh JS, Nakazawa K, Ban Y, Orita K, Shimatani A, Yao H, Shirafuji T, Nakamura H. Fracture healing on non-union fracture model promoted by non-thermal atmospheric-pressure plasma. PLoS One 2024; 19:e0298086. [PMID: 38626076 PMCID: PMC11020618 DOI: 10.1371/journal.pone.0298086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 04/18/2024] Open
Abstract
Non-thermal atmospheric-pressure plasma (NTAPP) is attracting widespread interest for use in medical applications. The tissue repair capacity of NTAPP has been reported in various fields; however, little is known about its effect on fracture healing. Non-union or delayed union after a fracture is a clinical challenge. In this study, we aimed to investigate how NTAPP irradiation promotes fracture healing in a non-union fracture model and its underlying mechanism, in vitro and in vivo. For the in vivo study, we created normal and non-union fracture models in LEW/SsNSlc rats to investigate the effects of NTAPP. To create a fracture, a transverse osteotomy was performed in the middle of the femoral shaft. To induce the non-union fracture model, the periosteum surrounding the fracture site was cauterized after a normal fracture model was created. The normal fracture model showed no significant difference in bone healing between the control and NTAPP-treated groups. The non-union fracture model demonstrated that the NTAPP-treated group showed consistent improvement in fracture healing. Histological and biomechanical assessments confirmed the fracture healing. The in vitro study using pre-osteoblastic MC3T3-E1 cells demonstrated that NTAPP irradiation under specific conditions did not reduce cell proliferation but did enhance osteoblastic differentiation. Overall, these results suggest that NTAPP is a novel approach to the treatment of bone fractures.
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Affiliation(s)
- Kosuke Saito
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mitsuhiro Okada
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Jun-Seok Oh
- Department of Physics and Electronics, Graduate School of Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Katsumasa Nakazawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshitaka Ban
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akiyoshi Shimatani
- Department of Orthopedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hana Yao
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tatsuru Shirafuji
- Department of Physics and Electronics, Graduate School of Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Ryskalin L, Fulceri F, Morucci G, Dell’Agli S, Soldani P, Gesi M. Treatment of delayed union of the forearm with extracorporeal shockwave therapy: a case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1286480. [PMID: 38033992 PMCID: PMC10684947 DOI: 10.3389/fendo.2023.1286480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Compared to other long bones, forearm fractures are particularly challenging due to the high rate of complications. These include malunion, delayed/nonunion, wrist and elbow movement reduction, and pain. Surgical procedure is considered the gold standard for managing delayed union and nonunion of the long bones. However, in the last decades, extracorporeal shockwave therapy (ESWT) has emerged as an effective and less invasive approach to enhance bone regeneration and fracture healing, avoiding major complications of surgical procedures. In contrast to the broad literature reporting good clinical results of ESWT in the treatment of nonunions, there is currently limited evidence regarding the clinical application of shock waves on long bone delayed fractures, particularly those of the forearm. In the present paper, we report a case of delayed bone healing of the diaphyseal region of the ulna treated with focused ESWT. The successful case experienced bone healing at the fracture site in less than 3 months after initial ESWT treatment. Acknowledging the limitation of reporting a case report, however, the remarkable clinical results and the absence of side effects contribute valuable information in support of the use of ESWT as an effective alternative to standard surgery for forearm fractures.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | | | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Stefania Dell’Agli
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, Pisa, Italy
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Hempe S, Bieler D, Braunegger G, Schilling T, Waldeck S, Kollig E. [Extracorporeal shockwave therapy as an alternative treatment in cases of posttraumatic delayed bone union]. Unfallchirurgie (Heidelb) 2023; 126:779-787. [PMID: 36018349 PMCID: PMC10520103 DOI: 10.1007/s00113-022-01225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Impaired posttraumatic bone healing is a relevant complication of fractures. Usually, the standard treatment is surgical revision. For about 30 years extracorporeal shockwave therapy (ESWT) has emerged as an alternative treatment option with similar consolidation rates but less complications. OBJECTIVE This article aims to present our data in context to the current literature MATERIAL AND METHODS: From 2007 to 2016 a total of 97 patients diagnosed with impaired posttraumatic bone healing were treated with ESWT. Clinical and demographic data of this population were retrieved and analyzed retrospectively. RESULTS The general consolidation rate was 60.8%. Multiple variables were analyzed. A preinterventional bone gap ≥ 5 mm, initial dislocation > ½ of the bone shaft, nicotine consumption and a long time span from fracture to ESWT (> 6 months) were found as factors which significantly impair bone healing after ESWT. CONCLUSION ESWT is a safe and promising alternative treatment option for delayed unions. Regarding risk factors of a poor outcome may be identified before and increase the rate of success.
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Affiliation(s)
- Sebastian Hempe
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - Dan Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Grit Braunegger
- Klinik für Nuklearmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Thomas Schilling
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - Stephan Waldeck
- Klinik für Radiologie und Neuroradiologie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Erwin Kollig
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
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Wang H, Shi Y. Extracorporeal shock wave treatment for post‑surgical fracture nonunion: Insight into its mechanism, efficacy, safety and prognostic factors (Review). Exp Ther Med 2023; 26:332. [PMID: 37346403 PMCID: PMC10280326 DOI: 10.3892/etm.2023.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/21/2023] [Indexed: 06/23/2023] Open
Abstract
Post-surgical fracture nonunion (PSFN) represents the failure to achieve cortical continuity at radiological examination after an orthopedic operation, which causes a considerable disease burden in patients with fractures. As one of the traditional treatment modalities, surgical therapy is associated with a high fracture union rate; however, post-surgical complications are not negligible. Therefore, less invasive therapies are needed to improve the prognosis of patients with PSFN. Extracorporeal shock wave treatment (ESWT) is a noninvasive method that presents a similar efficacy profile and favorable safety profile compared with surgical treatment. However, the application and detailed mechanism of ESWT in patients with PSFN remain unclear. The present review focuses on the mechanism, efficacy, safety and prognostic factors of ESWT in patients with PSFN, aiming to provide a theoretical basis for its application and improve the prognosis of these patients.
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Affiliation(s)
- Haoyu Wang
- Department of Orthopaedics, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
| | - Yaxuan Shi
- Department of Internal Medicine (Bone Oncology), Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
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Han K, Kang N, Yu X, Lu J, Ma Y. lncRNA NEAT1-let 7b-P21 axis mediates the proliferation of neural stem cells cultured in vitro promoted by radial extracorporeal shock wave. Regen Ther 2022; 21:139-147. [PMID: 35844294 PMCID: PMC9256974 DOI: 10.1016/j.reth.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 10/27/2022] Open
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Wuerfel T, Schmitz C, Jokinen LLJ. The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves. Biomedicines 2022; 10:biomedicines10051084. [PMID: 35625821 PMCID: PMC9138291 DOI: 10.3390/biomedicines10051084] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/14/2022] Open
Abstract
Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies address the molecular and cellular mechanisms of action of ESWT. However, to date, no uniform concept could be established on this matter. In the present study, we perform a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results are as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT is described in a study does not automatically mean that this mechanism is relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.
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Chen Q, Xia C, Shi B, Chen C, Yang C, Mao G, Shi F. Extracorporeal Shock Wave Combined with Teriparatide-Loaded Hydrogel Injection Promotes Segmental Bone Defects Healing in Osteoporosis. Tissue Eng Regen Med 2021; 18:1021-1033. [PMID: 34427911 DOI: 10.1007/s13770-021-00381-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Osteoporosis is a systemic bone disease characterized by decreased bone density and deterioration of bone microstructure, leading to an increased probability of fragility fractures. Once segmental bone defect occurs, it is easy to cause delayed union and nonunion. METHODS The aim of this study is to investigate the efficacy of extracorporeal shock wave (ESW) and teriparatide-loaded hydrogel (T-Gel) combined strategy on the cell activity and differentiation of osteoporosis derived bone marrow mesenchymal stem cells (OP-BMSCs) in vitro and bone regeneration in osteoporotic segmental bone defects in vivo. RESULTS In vitro, the strategy of combining ESW and T-Gel significantly enhanced OP-BMSCs proliferation, survival, migration, and osteogenic differentiation by up-regulating the alkaline phosphatase activity, mineralization, and expression of runt-related transcription factor-2, type I collagen, osteocalcin, and osteopontin. In the segmental bone defect models of osteoporotic rabbits, Micro-CT evaluation and histological observation demonstrated this ESW-combined with T-Gel injection significantly induced bone healing by enhancing the osteogenic activity of the local microenvironment in osteoporotic defects. CONCLUSION In conclusion, ESW-combined with T-Gel injection could regulate the poor osteogenic microenvironment in osteoporotic defects and show potential for enhancing fragility fractures healing.
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Affiliation(s)
- Qi Chen
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Chen Xia
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Binbin Shi
- Department of Orthopedic Surgery, Tongxiang First People's Hospital, Tongxiang, 314500, People's Republic of China
| | - Chuyong Chen
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Chen Yang
- Department of Orthopedic Surgery, No 1 People's Hospital of AkeSu, AkeSu, 843000, Xinjiang, People's Republic of China
| | - Guangfeng Mao
- Department of Orthopedic Surgery, The Third People Hospital of Zhuji, Shaoxing, 310014, People's Republic of China
| | - Fangfang Shi
- Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China.
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