Re: U/S for Fracture in a Horse

[Guest guest]

Do you have access to Shock wave therapy? IMHO that would be better. Pam Nichols DVM,CCRP Sent from my iPadDr. Pam Nichols cell office

I have an adult warmblood gelding that suffered an incomplete, non-displaced radius fracture. It is stable and surgery is not necessary at this point. But he is standing cross-tied so we would really like to stimulate some bone healing and get him off the wire ASAP. Was thinking we might consider therapeutic u/s, but have read in text that it may delay fracture healing at high doses(not well referenced)but LIPUS has shown to accelerate healing (lots on PUBmed on this).

Does anyone have any experience using u/s on fractures? If so what protocols have you used? We certainly don't want to make this worse!!!!

From reading the literature I cannot do LIPUS with the machine I have. It is an Intelect Vet u/s machine so can only control W/cm2, duty cycle, and have 1MHz and 3.3MHz with a 2 cm sound head (no pulse). The only protocol I could find for LIPUS is is 1.5 MHz ultrasound pulsed at 1 kHz, 20% duty cycle, 30 mW/cm - which I cannot do with the Intelect. In addition to machine protocol -how many sessions per week do you recommend (if anyone recommends it at all)?

Appreciate your help!

Brown DVM, DACVS-LA

[Guest guest]

Yes we do have access to shockwave, but not keen on using it in this case, for a variety of reasons. We are interested in other modalities however.

[Guest guest]

According to

http://prohealthcareproducts.com/blog/ultrasound-therapy-indications-and-contrai\

ndications/

" Other conditions governing the use of ultrasound therapy include avoiding

particular parts of the body that may be susceptible to negative side effects

from the treatment. It should not be used in areas where bones are growing.

Ultrasound devices should not be used where a fracture is healing, "

I don't know that I would use it over a fracture.

Roxanne Mazurkiewicz, SPT, RVT, CCRP

>

> I have an adult warmblood gelding that suffered an incomplete, non-displaced

radius fracture. It is stable and surgery is not necessary at this point. But

he is standing cross-tied so we would really like to stimulate some bone healing

and get him off the wire ASAP. Was thinking we might consider therapeutic u/s,

but have read in text that it may delay fracture healing at high doses(not well

referenced)but LIPUS has shown to accelerate healing (lots on PUBmed on this).

>

> Does anyone have any experience using u/s on fractures? If so what protocols

have you used? We certainly don't want to make this worse!!!!

>

> From reading the literature I cannot do LIPUS with the machine I have. It is

an Intelect Vet u/s machine so can only control W/cm2, duty cycle, and have 1MHz

and 3.3MHz with a 2 cm sound head (no pulse). The only protocol I could find

for LIPUS is is 1.5 MHz ultrasound pulsed at 1 kHz, 20% duty cycle, 30 mW/cm -

which I cannot do with the Intelect. In addition to machine protocol -how many

sessions per week do you recommend (if anyone recommends it at all)?

>

> Appreciate your help!

>

> Brown DVM, DACVS-LA

>

[Guest guest]

Thank you – but I hate going by non-referenced information in making a final decision. If you do a literature search there seems to be an abundance of information in refereed literature on LIPUS and its potential benefits (of various strengths), but other than an vague textbook reference and other non-referenced sources I cannot find information that it has been shown to be contraindicated. Does anyone have any referenced information or input on potential protocols? The push for this is coming from the trainer and owner, but not having good information on protocols or potential complications is making me hesitate a bit.

[Guest guest]

,I use my Class IIIb laser to heal fractures in both equines and canines. In my experience, the bones heal in about half the time, ie 2 weeks for splint bones and hair line canon bone fractures. I also have a current sesamoid proximal avulsion fracture that is healing well with laser; the horse was weight bearing and the bone was filling in the fracture line 1 week post-injury and after only 1 treatment at 5 joules/cm2 @ 500mW superpulsed. My acute injury dosing is between 3-5 joules/cm2 administered 2-3 times per week depending on owner's finances and availability. Then 1-2 weeks post injury, I use a higher dose 5-8 joules/cm2 dose 1-2 times a week. I started off using the human laser recommendations from the World Association of Laser Therapy (WALT) http://www.walt.nu/ and related arthritis dosing to bone healing; I know they are not the same thing but it was a place to start. Also, my laser came with built-in recommendations for different treatments.

I can send some radiographs as proof of healing, if you want to see or show the owner.Aslaug-- Aslaug Mandel, DVM, CVA, CCRT(pending)

Roaring Fork Veterinary ServicesP.O. Box 5687

Snowmass Village, CO 81615-5687www.roaringforkveterinary.com

Office: Fax: Cell/Text:

[Guest guest]

Hi ,I've attached a little bit on LIPUS... and what I could find in the literature regarding dosages, as well as the contraindications. The contraindications part was done as a literature review for a special edition of the Canadian Physiotherapy Association journal - Physiotherapy Canada - Dec 2010, I believe. The authors looks through the literature and textbooks to come up with this comprehensive - validated list of contraindications. Where the idea about not using it on fractures comes from using it on acute fractures, on a continuous setting... with the thought that the U/S waves can get under the periosteum and become trapped between the periosteum and bone, which could be painful. I was taught that this could be a way of 'looking for a fracture' in a case that was sent without x-ray and as a therapist you were concerns about a fracture. Used it ones on a kid for that purpose long time ago - fractured scaphoid - I was right! There is some 'opinion' that circulate about whether or not to utilize it before some primary callus forms or not... (with the same thought about trapping soundwaves and causing pain). Rule of thumb - ultrasound should never be painful.In regards to dosages. Sometimes the frustrating thing about research is that in order to study a particular technique/device etc on something 'new', researchers rely on what was already done in the literature in order to select what they will select - for therapy / intervention / or in this case dosage. I could not find in the literature where higher than 0.03W/cm2 or 0.05W/cm2 would be detrimental however. My advice would be to go as low as your machine will go (i.e. 0.1 W/cm2)... which I think your unit should be able to do. Time & utilization.... most of the research has been 'laboratory based' - so from what I have seen most of the studies are using it daily and anywhere from 3 minutes / session to 20 minutes per session. Again, from Physiotherapy Canada special edition on modalities... there was also reported as a blanket statement that U/S should be utilized for a minimum of 10 minutes... period... more if you can, but at least 10 minutes.DOSAGES•Ultrasound should be delivered for a minimum of 10 minutes (regardless of pulsed or continuous)–Houghton P, Nussbaum E, HoensA, & RennieS. Electrophysical Agents, Physiotherapy Canada62(5) Special Issue, 2010I'd try to do it 2 - 3 x a week if able... recognizing the practicalities of such things in clinical practice could be difficult. I'm not certain that once a week or less would make any difference what so ever.I hope this helps... The mini review paper is attached.Cheers,Laurie Edge-

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCEO,Four Leg Rehab Inc.Canine Rehab Educational ResourcesWWW.FOURLEG.COMCheck it out!!

Thank you – but I hate going by non-referenced information in making a final decision. If you do a literature search there seems to be an abundance of information in refereed literature on LIPUS and its potential benefits (of various strengths), but other than an vague textbook reference and other non-referenced sources I cannot find information that it has been shown to be contraindicated. Does anyone have any referenced information or input on potential protocols? The push for this is coming from the trainer and owner, but not having good information on protocols or potential complications is making me hesitate a bit.

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Ultrasound for Fracture Healing.pdf

[Guest guest]

Why not use Alpha-Stim MET? Research initiated by orthopedic surgeon Dr. Becker, MD (see book Body Electric) for fractures. Stimulates blastema to regenerate. Plus treats pain as well and reduces scarring. Ava Frick, DVM From: VetRehab [mailto:VetRehab ] On Behalf Of jenbrowndvmSent: Tuesday, July 24, 2012 9:54 PMTo: VetRehab Subject: U/S for Fracture in a Horse I have an adult warmblood gelding that suffered an incomplete, non-displaced radius fracture. It is stable and surgery is not necessary at this point. But he is standing cross-tied so we would really like to stimulate some bone healing and get him off the wire ASAP. Was thinking we might consider therapeutic u/s, but have read in text that it may delay fracture healing at high doses(not well referenced)but LIPUS has shown to accelerate healing (lots on PUBmed on this).Does anyone have any experience using u/s on fractures? If so what protocols have you used? We certainly don't want to make this worse!!!! From reading the literature I cannot do LIPUS with the machine I have. It is an Intelect Vet u/s machine so can only control W/cm2, duty cycle, and have 1MHz and 3.3MHz with a 2 cm sound head (no pulse). The only protocol I could find for LIPUS is is 1.5 MHz ultrasound pulsed at 1 kHz, 20% duty cycle, 30 mW/cm - which I cannot do with the Intelect. In addition to machine protocol -how many sessions per week do you recommend (if anyone recommends it at all)? Appreciate your help! Brown DVM, DACVS-LA