Conceptos Categóricos

TERAPIA ULTRASONICA Y CONSOLIDACION DE LAS FRACTURAS

TERAPIA ULTRASONICA Y CONSOLIDACION DE LAS FRACTURAS

(especial para SIIC © Derechos reservados)
Desde la perspectiva de la sociedad, el tratamiento incruento de las fracturas tibiales de baja energía asociado con ultrasonido de baja intensidad, podría ser económicamente beneficioso.
busse9.jpg Autor:
Busse, Jason W
Columnista Experto de SIIC

Institución:
Department of Clinical Epidemiology and Biostatistics McMaster Health Sciences Centre Ontario, Canada


Artículos publicados por Busse, Jason W
Coautores
Mohit Bhandari, MD, MSc, FRCSC*  Abhaya V. Kulkarni, MD, PhD, FRCSC** 
Department of Clinical Epidemiology and Biostatistics and Division of Surgery, McMaster University, Hamilton, Canada*
Division of Population Health Sciences, Hospital for Sick Children, Toronto, Canada**
Recepción del artículo
13 de Septiembre, 2004
Aprobación
27 de Septiembre, 2004
Primera edición
8 de Abril, 2005
Segunda edición, ampliada y corregida
4 de Abril, 2007

Resumen
La relevancia que tiene un tratamiento con pulsos de ultrasonido de baja intensidad para la consolidación de las fracturas es controvertida. Esta revisión resume la investigación de los autores acerca de la terapia ultrasónica en el manejo de las fracturas. Nuestra encuesta de las creencias y las conductas de los cirujanos ortopedistas y de los estudiantes avanzados de fisioterapia encontró que la terapia ultrasónica es utilizada rara vez, debido fundamentalmente a que es vista como carente de pruebas en cuanto a sus beneficios y a que no es fácilmente accesible. Existen datos sugestivos tomados de ensayos aleatorios de que el ultrasonido de baja intensidad podría reducir considerablemente el tiempo de consolidación de las fracturas, particularmente en el caso de aquellas tratadas incruentamente. Los beneficios del ultrasonido aplicado a las fracturas tratadas quirúrgicamente son aún inciertos. Nuestro análisis económico sugiere que, tanto desde la perspectiva gubernamental como desde la social, el enclavado endomedular fresado es el tratamiento de elección para las fracturas diafisiarias de la tibia, tanto cerradas como expuestas tipo I; sin embargo, existen además hechos indicativos de que desde la perspectiva de la sociedad, el tratamiento de las fracturas de la tibia de baja intensidad con reducción incruenta e inmovilización con yeso, en combinación con terapia ultrasónica, podría también ser una intervención económicamente beneficiosa. Se necesitan ensayos más grandes para dilucidar al papel que la terapia ultrasónica tiene en la consolidación de las fracturas.

Palabras clave
Ultrasonido, consolidación de las fracturas, rentabilidad, enyesado, enclavado endomedular


Artículo completo

(castellano)
Extensión:  +/-8.95 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
The impact of low intensity, pulsed ultrasound on fracture healing is controversial. This review summarizes the authors’ research on therapeutic ultrasound in fracture management. Our survey of orthopaedic surgeons and senior physiotherapy students found that use of therapeutic ultrasound is rare, due primarily to a perceived lack of evidence and lack of availability. There is evidence from randomized trials that low intensity ultrasound may significantly reduce the time to fracture healing, particularity in those fractures treated non-operatively. The benefit of ultrasound following operatively-managed fractures remains uncertain. Our economic analysis suggests that, from both governmental and societal perspectives, reamed intramedullary nailing is the treatment of choice for closed and open grade I tibial shaft fractures; however, there is evidence from a societal perspective that treatment of low energy tibial fractures with therapeutic ultrasound and casting may also be an economically-sound intervention. Larger trials are needed to resolve the role of therapeutic ultrasound in fracture healing.

Key words
Ultrasonics, fracture healing, economics, plaster cast, intramedullary nailing


Full text
(english)
para suscriptores/ assinantes

Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Ortopedia y Traumatología
Relacionadas: Medicina Interna



Comprar este artículo
Extensión: 8.95 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Busse, Jason W.
Patrocinio y reconocimiento:
Agradecimientos: Agradecemos al Dr. Wolfram Bosenberg por la traducción de una comunicación publicada en Alemán.23
Bibliografía del artículo
  1. Heckman JD, Sarasohn-Kahn J. The economics of treating fracture healing. Bull Hosp Jt Dis. 1997; 56: 63-72.
  2. Russell TA: Fractures of the tibial diaphysis. In Levine AM (ed) Orthopaedic Knowledge Update Trauma. Rosemont IL, American Academy of Orthopaedic Surgeons, 171-9, 1996
  3. Turen CH, Burgess AR, Vanco B. Skeletal stabilization of tibial fractures associated with acute compartment syndrome. Clin Orthop. 1995; 315:163-9.
  4. Watson JT, Anders M, Moed B. Management strategies for bone loss in tibial fractures Clin Orthop. 1995; 315: 138-53.
  5. Burgess AR, Poka A, et al. Pedestrian tibial injuries. J Trauma. 1987; 27: 596-601.
  6. Blick SS, Brumback RJ, Poka A, et al. Compartment syndrome in open tibial fractures. J Bone Joint Surg [Am]. 1986; 68A: 1348-53.
  7. Sarmiento A, Sharpe FE, Ebramzadeh E et al. Factors influencing outcome of closed tibial fractures treated with functional bracing. Clin Orthop. 1995; 315: 8-25.
  8. Wells PS, Hirsh J, Anderson DR, et al . Accuracy of clinical assessment of deep vein thrombosis. Lancet. 1995; 345: 1326-30.
  9. Geerts, W.H.; Code, K.I.; Jay, R.M.; et al. A prospective study of venous thromboembolism after major trauma. New Engl J Med. 1994; 333: 1601–1606.
  10. Abelseth, G.; Buckley, R.E.; Pineo, G.E.; et al. Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. J Orthop Trauma. 1996; 10: 230–235.
  11. Busse JW, Bhandari M. Therapeutic Ultrasound and Fracture Healing: A Survey of Beliefs and Practices. Accepted for publication in the Archives of Physical Medicine and Rehabilitation.
  12. Busse JW, Bhandari M, Kulkarni AV, Tunks E. The Effect of Low-Intensity Pulsed Ultrasound Therapy on Time to Fracture Healing: a Meta-Analysis. Canadian Medical Association Journal. 2002; 166: 437-441
  13. Busse JW, Bhandari M, Sprague S, Johnson-Masotti AP, Gafni A. A Cost Analysis of Management Strategies for Closed and Open Grade I Tibial Shaft Fractures. Submitted for publication
  14. Jadad AR, Moore RA, Carol D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ. Assessing the quality of randomized clinical trials: is blinding necessary Controlled Clin Trials. 1996; 17: 1-12.
  15. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-58.
  16. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60.
  17. Cook SD, Ryaby JP, McCabe J, et al. Acceleration of tibia and distal radius fracture healing in patients who smoke. Clin Orthop Rel Res. 1997; 337: 198-207.
  18. Frankel VH, Mizuho K. Management of non-union with pulsed low-intensity ultrasound therapy-international results. Surg Technol Int. 2002; 10: 195-200.
  19. Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LR. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. J Bone Joint Surg [Am]. 1997; 79-A: 961-973.
  20. Emami A, Petrén-Mallmin M, Larsson S. No effect of low-intensity ultrasound on healing time of intrameduallary fixed tibial fractures. J Orthop Trauma. 1999; 13: 252-257.
  21. Emami A, Larsson A, Petrén-Mallmin M, Larsson S. Serum bone markers after intrameduallary fixed tibial fractures. Clin Orthop Rel Res. 1999; 368: 220-229.
  22. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg [Am]. 1994; 76-A: 26-34.
  23. Mayr E, Rudzki M-M, Rudzki M, Borchardt B, Haüsser H, Rüter. Beschleunigt niedrig intensiver, gepulster ultraschall die heilung von skaphoidfrakturen Handchir Mikrochir Plast Chir. 2000; 32: 115-122.
  24. Leung KS, Lee WS, Tsui HF, Liu PP, Cheung WH. Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound. Ultrasound Med Biol. 2004; 30: 389-395.
  25. Kahn J. Ultrasound. In: Kahn J. editor. Principles and practice of electrotherapy. 3rd ed. New York: Churchill Livingstone, 1994. p 49-68.
  26. Pauls JA, Reed KL, editors. Contraindications for physical agents and modalities [appendix]. In: Quick reference to physical therapy. Gaithersburg: Aspen Publishers, 1996. p 697-703.
  27. Buxton BP, Ryan J, Starkey C. Ultrasound. In: Starkey C, editor. Therapeutic modalities. 2nd ed. Philadelphia: F.A.Davis Company, 1999. p 269-304.
  28. McDiarmid T, Ziskin MC, Michlovitz SL. Therapeutic ultrasound. In: Michlovitz SL, editor. Thermal agents in rehabilitation. 3rd ed. Philadelphia: F.A.Davis Company, 1996. p 168-212.
  29. Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2000; 2: CD000314.
  30. Ritchie JV, Munter DW. Emergency department evaluation and treatment of wrist injuries. Emerg Med Clin North Am 1999; 17: 823-42.
  31. Rodriguez-Merchan EC. Management of comminuted fractures of the distal radius in the adult. conservative or surgical Clin Orthop 1998; 353: 53-62.
  32. Meyr E, Frankel V, Rüter A. Ultrasound – an alternative healing method for nonunions Arch Orthop Trauma Surg 2000; 120: 1-8.
  33. Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, Schemitsch EH. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg [Br] 2002; 84-B: 15-8.
  34. Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta III P, Sprague S, Schemitsch EH. A lack of consensus in the assessment of fracture healing among orthopaedic surgeons. J Orthop Trauma 2002; 16: 562-6.
  35. Downing ND, Griffin DR, Davis TR. A comparison of the relative costs of cast treatment and intramedullary nailing for tibial diaphyseal fractures in the UK. Injury. 1997; 28: 373-375.
  36. Sprague S, Bhandari M. An economic evaluation of early versus delayed operative treatment in patients with closed tibial shaft fractures. Arch.Orthop Trauma Surg 2002; 122: 315-323.
  37. Toivanen JA, Hirvonen M, Auvinen O et al. Cast treatment and intramedullary locking nailing for simple and spiral wedge tibial shaft fractures--a cost benefit analysis. Ann.Chir Gynaecol. 2000; 89: 138-142.
  38. Karladani AH, Granhed H, Edshage B, Jerre R, Styf J. Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients. Acta Orthop Scand. 2000 Apr;71(2):160-167.
  39. Hooper GJ, Keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. J Bone Joint Surg Br. 1991; 73: 83-85.
  40. Van der Linden W, Larsson K. Plate fixation versus conservative treatment of tibial shaft fractures. A randomized trial. J Bone Joint Surg [Am]. 1979 Sep;61(6A):873-878.
  41. Abdel-Salam A, Eyres KS, Cleary J. Internal fixation of closed tibial fractures for the management of sports injuries. Br J Sports Med. 1991; 25: 213-217.
  42. Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK. Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation. Zhonghua Yi Xue Za Zhi (Taipei). 1996a; 57(2): 124-133.
  43. Keating JF, O'Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg [Am]. 1997; 79(3): 334-341.
  44. Court-Brown CM, Will E, Christie J, McQueen MM. Reamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures. J Bone Joint Surg [Br]. 1996; 78: 580-583.
  45. Blachut PA, O'Brien PJ, Meek RN, Broekhuyse HM. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg [Am]. 1997; 79: 640-646.
  46. Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000; 14: 187-193.
  47. Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D. Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomized prospective study. J Orthop Trauma. 2000; 14: 554-558.
  48. Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK. Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment. J Trauma. 1996b; 40: 987-991.

 
 
 
 
 
 
Clasificado en
Artículos originales>
Expertos del Mundo

Especialidad principal:
Ortopedia y Traumatología


Relacionadas:
Medicina Interna
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
-->