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

2. Young Researchers Meeting Rome Rome, 9th February 2010 Vibration Energy in Orthopaedic Disabilities Aim: Assess efficacy of Local Vibrations (LV) in delayed-union and non-union fractures through therapeutic vibration exercise by analysing radiographic appereance Local Vibrations and Bone Regeneration: Case Study

3. Young Researchers Meeting Rome Rome, 9th February 2010 Vibration Energy in Orthopaedic Disabilities Mechanical Factors vs Body Response improve muscular functions increase bone regeneration process by stimulating the muscle increase remineralization activity by triggering osteoblasts Mechanical factors hold an important role in human body adaptive response, as vibrations:

4. 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)

5. Young Researchers Meeting Rome Rome, 9th February 2010 Vibration Energy in Orthopaedic Disabilities to strengthen the muscle after peripheral nervous system lesions or myo-osteo-articular lesions to reinforce muscle and minimize muscle hypotrophy after orthopedic surgery ? Why Local Vibrations? Clinical necessity: focus effects of treatment

6. Young Researchers Meeting Rome Rome, 9th February 2010 Vibration Energy in Orthopaedic Disabilities 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 ? Why Local Vibrations? Clinical necessity: focus effects of treatment

7. 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 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. 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 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. 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

10. 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 Non-union: cessation of all reparative processes of healing without bone union Delayed-union: prolongation of time to fracture union

11. 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

12. Case Study Young Researchers Meeting Rome Rome, 9th February 2010 Characteristics age51 sexmale weight108 kg height185 cm  Male patient presenting right tibia fracture Anamnesis 2004Right tibia decomposed fragmented fracture which demanded reduction and fixation with plates and screws and metal cerclage 2008Right leg TC showed redundant callus with no consolidation and reduced bone density: non-union fracture diagnosis

13. Case Study Young Researchers Meeting Rome Rome, 9th February 2010  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. Case Study Young Researchers Meeting Rome Rome, 9th February 2010  Since the early applications: a reduction of perilesion edema was shown the algic symptomatology improved improvements in paresthetic symptomatology

15. Case Study Young Researchers Meeting Rome Rome, 9th February 2010 Cirtometria AAII EntranceDischarge Right legLeft legRight legLeft leg Peri-malleolar29.5cm27cm28.5cm27cm 5cm over medial malleolus28.5cm24cm28cm24cm 10cm over medial malleolus29.5cm25.5cm28.5cm25.5cm ScalesEntranceDischarge LEFS31/8046/80 BARTHEL INDEX98/100100/100 McGiLL PAIN QUEST.25/6010/60  Clinical results: independent ambulation disappearance of perimalleolar edema

16. Case Study Young Researchers Meeting Rome Rome, 9th February 2010  Radiographic appearance: presence of bone repair activity around the fracture line EntranceDischarge Follow-up

17. Case Study Young Researchers Meeting Rome Rome, 9th February 2010 EntranceDischarge Follow-up  Radiographic appearance: presence of bone repair activity around the fracture line

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