Читать книгу Fractures in the Horse - Группа авторов - Страница 162

Pulsed electromagnetic fields have been used with some success for stimulating fracture healing, especially in cases of delayed healing in people (Chapter 15). The technique has been used for over 40 years and functions by passing a current through a conductor to generate a magnetic field [81]. Although most studies have shown a positive effect used in vivo, ex vivo and clinical trials, some have shown none or negative effects. The variability may be explained by the manner of application (frequency, timing and dose), the stage of healing at which it is applied, tissue densities and application method [81]. Although there is no recent evidence to support its use in horses, some older studies reported a positive influence on bone repair. Meta‐analysis of the human literature also suggests that it can be efficacious [82].

Electric stimulation therapy has been studied for decades; although experimental use has generally shown positive effects, its efficacy in clinical trials is mixed [83]. It is theorized that bone formation is stimulated by electrical fields generated within the bone.

Low‐intensity pulsed ultrasonography (LIPUS) has also been advocated for use in fracture repair (Chapter 15). The ultrasound waves are assumed to cause material deformation of bone at the site of application and upregulate cellular and biochemical processes to stimulate bone formation [84, 85]. Meta‐analysis of clinical studies shows modest effects overall [86]. There is some evidence that LIPUS is slightly better than electrical stimulation early in fracture repair [87]. Although low‐intensity ultrasound has some evidence of efficacy in humans [88], limited use in horses has shown no positive effects [89].

There is some evidence that extracorporeal shockwave therapy (ESWT) can effectively be used to treat non‐union fractures in humans [90]. Meta‐analysis of its use in humans showed no differences in healing of acute fractures, but there was a trend for increased comfort in treated patients [88]. ESWT has been shown to decrease lameness in equine osteoarthritis with a simultaneous increase in bone biomarkers [91, 92]. It has also been shown to have analgesic properties in some studies, but not in others [93]. There are some indications that ESWT can promote osteogenesis in horses [94] and that the mechanism may be induction of bone microfracture [95]. However, there is no evidence that ESWT can enhance fracture healing in horses.

Vibration therapy has been introduced to the equine market. In humans and experimental animals, the tendency is for bone healing to be improved in individuals with osteoporosis [96]. Although it has been suggested for equine rehabilitation purposes (Chapter 15) [97], its use to stimulate bone healing is questionable.

Hyperbaric oxygen therapy has been advocated to stimulate bone healing, but systematic reviews of the therapy have been inconclusive [98]. Considering the cost and need to transport the animal, it is unlikely to be clinically viable.