Abstract
Objective: To analyze the influence of steel plates for osteosynthesis on the velocity of ultrasound propagation (VU) through the bone. Methods: The transverse coronal and sagittal velocity of ultrasound propagation underwater were measured on the intact bone and then on assemblies of the same bone with two types of osteosynthesis plates (DCP and semi tubular), fixed onto the dorsal side of the bones. The first arriving signal (FAS) was the ultrasound parameter used, taking the coronal and sagittal diameters as the distances to calculate velocity. Intergroup statistical comparisons were made at significance level of 1% (p<0.01). Results: Velocity was higher on the intact bones than on the bone-plate assemblies and higher for the semitubular than for the compression plates, although differences were not statistically significant for most comparisons (p=0.0132 to 0.9884), indicating that the steel plates do not interfere significantly with ultrasound wave propagation through the bone-plate assemblies. Conclusion: The velocity reduction effect was attributed to the greater reflection coefficient of the steel as compared to that of bone and water. Ultrasonometry can, thus, be used in the evaluation of healing of fractures fixed with steel plates. Experimental Study.
Highlights
It is well established that ultrasound propagation velocity (UV) consistently increases with the healing of a fracture, while attenuation consistently decreases, with both parameters slowly approaching normal values during the remodeling phase
The percentage of the emitted ultrasound energy reflected by the interfaces is 88%, 72% and 14%, respectively, resulting in the fact that only about 12% and 28% go through the plate and the bone, respectively, not considering the re-reflection inside each material
The results of many investigations demonstrate that transmission ultrasonometry can precisely indicate the healing status of a fracture, introducing a new diagnostic method with great potential for clinical application, with the advantage that it does not involve ionizing radiation.[23,24]
Summary
Transmission ultrasonometry has been studied as an ancillary method for the diagnosis of the healing status of fractures by means of experimental, clinical and laboratory bench investigations.[1,2,3,4,5,6] It basically consists of measuring the ultrasound velocity and attenuation, which are fundamental properties of the bone that vary according to structure, density, elasticity and other biomechanical properties, supplying an indirect measure of these properties.[7,8,9] It is well established that ultrasound propagation velocity (UV) consistently increases with the healing of a fracture, while attenuation consistently decreases, with both parameters slowly approaching normal values during the remodeling phase This behavior has a potential for clinical application for the diagnosis of the healing status of a fracture and its anomalies.[10,11] Almost all previous investigations about the ultrasonometric diagnosis of the healing status have been conducted on fractures treated conservatively[4,11] or with laboratory (phantoms) or computer models without the interference of any metal implant.[12,13] due to a number of advantages, the conservative methods for the treatment of fractures are progressively being left aside in favor of modern surgical methods. This hypothesis has not yet been adequately tested after the pioneering study by Saulgozis and collaborators,[10] who presented the problem but did not deepen the analysis
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