Transcript Local Vibrations - Young Researcher Meeting

Application of Local Vibrations in Delayed
and Non-union Fractures: a Case Study
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C. Trombetta Eng MA PhD , P. Abundo Eng MA , A. Civitella MD ,
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N. Rosato FP and C. Foti MD FP
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Medical Engineering Service, Fondazione Policlinico Tor Vergata, Rome
PhD student in Advanced Technology in Rehabilitation Medicine, Tor Vergata University, Rome
Tor Vergata University, Physical and Rehabilitation Medicine, Public Health Department, Rome
Vibration Energy in Orthopaedic Disabilities
Local Vibrations and Bone Regeneration:
Case Study
Aim:
Assess efficacy of Local Vibrations (LV) in delayed-union
and non-union fractures through therapeutic vibration
exercise by analysing radiographic appereance
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Mechanical Factors vs Body Response
Mechanical factors hold an important role in human body
adaptive response, as vibrations:
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improve muscular functions
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increase bone regeneration
process by stimulating the muscle
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increase remineralization activity
by triggering osteoblasts
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Vibration Exercise
Whole Body Vibrations (WBV)
Upper Arm Vibrations (UAV)
Local Vibrations (LV)
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Why Local Vibrations?
Clinical necessity: focus effects of treatment
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to strengthen the muscle after
peripheral nervous system lesions
or myo-osteo-articular lesions
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to reinforce muscle and minimize
muscle hypotrophy after
orthopedic surgery
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Why Local Vibrations?
Clinical necessity: focus effects of treatment
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to improve muscle distensibility in
joint recovery, in posture changes
caused by retraction myo-tendon
and in muscle lesions
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to amplify the proprioceptive
afferents in balance alterations and
proprioceptive recovery after
orthopedic lesions
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Why Local Vibrations?
Clinical necessity: focus effects of
treatment on specific body segments
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Body is a system with n-degrees of
freedom, every segment has its own
resonance frequency
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Vibration effects depend on frequency,
time and level of exposure
Solution: LV
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Design of a Specific Device
Device dedicated to LV application for
bone regeneration and muscle strength
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allow the operator to increase
the strain applied on the subject
in relation to different
applications
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comparable geometry with limb
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protect the operator from
vibratory stress
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Design of a Specific Device
Device dedicated to LV application for
bone regeneration and muscle strength
Medical Engineering and Rehabilitation Medicine Department at the Tor Vergata University
in collaboration with the company Boscosystemlab
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Non-union and Delayed-union Fractures
Failure of a fractured bone to
heal normally
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Non-union: cessation of all
reparative processes of healing
without bone union
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Delayed-union: prolongation
of time to fracture union
Young Researchers Meeting Rome
Rome, 9th February 2010
Vibration Energy in Orthopaedic Disabilities
Non-union and Delayed-union Fractures
Differentiation between delayed union and non union is often
based on radiographic criteria and time
Failure to show any progressive change in the radiographic
appearance is evidence of non-union
The changes in radiographic appearance may be slight
radiographs should be scrutinized monthly
Young Researchers Meeting Rome
Rome, 9th February 2010
Case Study
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Male patient presenting right tibia fracture
Anamnesis
2004
Right tibia decomposed fragmented fracture which demanded
reduction and fixation with plates and screws and metal cerclage
2008
Right leg TC showed redundant callus with no consolidation and
reduced bone density: non-union fracture diagnosis
Characteristics
age
51
sex
male
weight
108 kg
height
185 cm
Young Researchers Meeting Rome
Rome, 9th February 2010
Case Study
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Monthly program was scheduled consisting in:
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daily treatments of 6 series
of 5 repetitions at 35Hz
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30’’ time application for each
repetition
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1’ pause between repetitions
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1’ 30’’ pause between series
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Application on the heel
Young Researchers Meeting Rome
Rome, 9th February 2010
Case Study
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Since the early applications:
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a reduction of perilesion edema was shown
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the algic symptomatology improved
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improvements in paresthetic symptomatology
Young Researchers Meeting Rome
Rome, 9th February 2010
Case Study
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Clinical results:
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independent ambulation
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disappearance of perimalleolar edema
Cirtometria AAII
Entrance
Discharge
Right leg
Left leg
Right leg
Left leg
Peri-malleolar
29.5cm
27cm
28.5cm
27cm
5cm over medial malleolus
28.5cm
24cm
28cm
24cm
10cm over medial malleolus
29.5cm
25.5cm
28.5cm
25.5cm
Scales
Entrance
Discharge
LEFS
31/80
46/80
BARTHEL INDEX
98/100
100/100
McGiLL PAIN QUEST.
25/60
10/60
Young Researchers Meeting Rome
Rome, 9th February 2010
Case Study
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Radiographic appearance:
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presence of bone repair activity
around the fracture line
Entrance
Young Researchers Meeting Rome
Discharge
Follow-up
Rome, 9th February 2010
Case Study
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Radiographic appearance:
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presence of bone repair activity
around the fracture line
Entrance
Young Researchers Meeting Rome
Discharge
Follow-up
Rome, 9th February 2010
Thank you
Chiara Trombetta
[email protected]
Paolo Abundo
[email protected]