Application of Local Vibrations in Delayed and Non-union Fractures: a Case Study

1. Application of Local Vibrations in Delayed and Non-union Fractures: a Case Study C. Trombetta Eng MA PhD1,2, P. Abundo Eng MA1, A. Civitella MD3, N. Rosato FP1 and C. Foti MD FP3 1Medical Engineering Service, Fondazione Policlinico Tor Vergata, Rome 2PhD student in Advanced Technology in Rehabilitation Medicine, Tor Vergata University, Rome 3Tor Vergata University, Physical and Rehabilitation Medicine, Public Health Department, Rome

2. 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

3. Mechanical Factors vs Body Response • Mechanical factors hold an important role in human body adaptive response, as vibrations: • improve muscular functions • increase bone regeneration process by stimulating the muscle • increase remineralization activity by triggering osteoblasts

4. Vibration Exercise Whole Body Vibrations (WBV) Upper Arm Vibrations (UAV) Local Vibrations (LV)

5. Why Local Vibrations? • Clinical necessity: focus effects of treatment • to strengthen the muscle after peripheral nervous system lesions or myo-osteo-articular lesions • to reinforce muscle and minimize muscle hypotrophy after orthopedic surgery

6. Why Local Vibrations? • Clinical necessity: focus effects of treatment • to improve muscle distensibility in joint recovery, in posture changes caused by retraction myo-tendon and in muscle lesions • to amplify the proprioceptive afferents in balance alterations and proprioceptive recovery after orthopedic lesions

7. Why Local Vibrations? • Clinical necessity: focus effects of treatment on specific body segments • Solution: LV • Body is a system with n-degrees of freedom, every segment has its own resonance frequency • Vibration effects depend on frequency, time and level of exposure

8. Design of a Specific Device • Device dedicated to LV application for bone regeneration and muscle strength • allow the operator to increase the strain applied on the subject in relation to different applications • comparable geometry with limb • protect the operator from vibratory stress

9. 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

10. Non-union and Delayed-union Fractures • Failure of a fractured bone to heal normally • Non-union: cessation of all reparative processes of healing without bone union • Delayed-union: prolongation of time to fracture union

11. 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

12. Male patient presenting right tibia fracture

13. Monthly program was scheduled consisting in: • daily treatments of 6 series of 5 repetitions at 35Hz • 30’’ time application for each repetition • 1’ pause between repetitions • 1’ 30’’ pause between series • Application on the heel

14. Since the early applications: • a reduction of perilesion edema was shown • the algic symptomatology improved • improvements in paresthetic symptomatology

15. independent ambulation • disappearance of perimalleolar edema • Clinical results:

16. presence of bone repair activity around the fracture line • Radiographic appearance: Follow-up Entrance Discharge

17. presence of bone repair activity around the fracture line • Radiographic appearance: Follow-up Entrance Discharge

18. Thank you Chiara Trombetta chiara.trombetta@yahoo.it Paolo Abundo paolo.abundo@yahoo.it