The Effects of Low Intensity Ultrasound on Fracture Healing in Diabetics

Authors: Michael Coords, Eric Breitbart, David Paglia, Nikolas Kappy, Ankur Gandhi, Jessica Cottrell, Natalie Cedeno, Neill Pounder, J. Patrick O'Connor, Sheldon S. Lin.
Source: https://onlinelibrary.wiley.com/doi/full/10.1002/jor.21223

This study compares femoral diaphyseal fracture consolidation between a group of healthy rats (n=15), a group of rats with Diabetes Mellitus (n=15) and a group of rats with Diabetes Mellitus treated with LIPUS low-frequency ultrasound. intensity (n=15).

The following parameters were taken: PCR and ELISA for the measurement of growth factors, Histomorphometry to evaluate the formation of cartilage and Immunohistochemistry to show the neovascularization of the fracture site.
Relevant results:General health
  • The group of rats with DM presented impaired expression of all parameters (growth factors, cartilage formation and neovascularization).
  • The use of LIPUS did not affect the blood glucose level.

Growth Factors / PCR and ELISA

  • TGF-β: at day 7 the level in the DM + LIPUS group was significantly higher than in the DM group (1.49 ± 0.21; 0.87 ± 0.12).
  • IGF-1: at day 7 the level in the DM + LIPUS group was higher than in the DM group (0.46 ± 0.09; 0.39 ± 0.09).
  • VEGF: at day 7 the level in the DM + LIPUS group was significantly higher than in the DM group (0.058 ± 0.01; 0.030 ± 0.009).

Cartilage Formation / Histomorphometry

  • On day 7, the DM + LIPUS group shows a significantly higher percentage of cartilage than the DM group (8.49 ± 1.78%; 4.28 ± 2.63%).
  • On day 10, the DM + LIPUS group shows a significantly higher percentage of cartilage than the DM group (20.20 ± 6.65%; 12.20 ± 4.32%).

Neovascularization / Immunohistochemistry

  • PECAM-1: The blood vessel density (BV) of the DM + LIPUS group showed 77.6% more bone density than the control DM group (1.95 ± 0.569; 1.098 ± 0.226).

It can be concluded that LIPUS may have a role as an adjuvant therapy for the treatment of fractures in patients with Diabetes Mellitus, since it increases the factors that intervene in the bone regeneration process that are affected by the pathology.