PEMF in the Treatment of Fresh Distal Radius Fractures

Tel-Aviv Sourasky Medical Center50 enrolled

Overview

Distal radial fractures (DRF) are the most common fractures encountered in health care. Annualized estimates in the United States alone suggest an incidence of approximately 640,000 cases, and rising, per year. Most fractures may be treated in a plaster cast, but unstable fractures tend to displace without a surgical procedure. 1 Pulsed electromagnetic field (PEMF) is one modality commonly used to stimulate bone generation throughout various clinical settings including orthoapedic surgery. PEMF has been shown to primarily effect vascular generation, formation and neovascularization2,3. This may help decrease time to healing and allow patients to return to normal activities sooner. Additional study demonstrated that PEMF exposure increased cell proliferation, adhesion and the osteogenic commitment of MSCs, even in inflammatory conditions. In this in-vitro model PEMFs increased the expression of anti-inflammatory cytokines, such as IL-10, and reduced the expression of the pro-inflammatory cytokine IL-1 4. The distal radius fracture was chosen as the model to test the effects of PEMF treatment because it includes both trabecular and cortical bone, is accessible for radiographs, has little soft tissue that can distort the radiograph, and is amenable to multiple functional endpoints. The purpose of the study is to determine whether the use of FHP by means of pulsed electromagnetic fields in acute distal radius fractures will accelerate healing both clinically and radiotralogically

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Distal Radius Fracture

Interventions

Fracture Healing Patch (FHP)DEVICE

The Fracture Healing Patch (FHP) is an external silicone patch that contains inside micro-electronic modulus, which generates a pulsed electromagnetic field (PEMF) to enhance and improve fracture healing. The FHP is placed under the cast at the fracture site. Throughout the treatment period the FHP produces a pulsed electromagnetic field. The FHP houses a battery, a microelectronic module and a coil that produce the PEMF.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Subjects with closed unilateral dorsally angulated fracture of the distal radius (Colles') visible by x-ray. 2. Subjects treated conservatively by immobilization ± closed reduction 3. Age \>18 years 4. Subjects able to adhere to the visit schedule and protocol requirements and be available to complete the study. Exclusion Criteria: 1. Subjects with intra articular fracture or extra-articular fracture that meets the criteria for operative fracture fixation. 2. Subjects with pins or plates in the wrist 3. Sustained previous fractures or bone surgery in the currently fractured distal forearm 4. Synovial pseudarthrosis 5. Subjects with multiple trauma (several fractures at once) 6. Subjects suffering from joint diseases that affect the function of the wrist and/or hand of the injured arm. 7. Pregnancy 8. Women who are breast-feeding. 9. Women of childbearing potential and not using a medically accepted form of contraception when sexually active. 10. presence of a life supporting implanted electronical device

Outcomes

Primary Outcomes

Change from baseline in radiographic fracture healing

Change from baseline in radiographic fracture healing will be measured. Radiographic healing will be defined as the interval in days between the occurrence of the fracture and the time when bridging in three of four cortices is seen on X-ray images. A measurement will be made at each follow up evaluation by using Radius Union Scoring System (RUSS) score

Time frame: Radiographic images (X-ray) will be performed for each subject from day 0 and onward: week 2,4, 6 and 12.

Secondary Outcomes

Change from baseline in improvement of function

For assessment of functional deficit, disability and pain level, the Patient Rated Wrist Evaluation (PRWE) will be used. The PRWE is an easy 15-item questionnaire designed to measure wrist pain and disability in activities of daily living. The PRWE allows patients to rate their levels of wrist pain and disability. Pain Score = Sum of the 5 pain items (out of 50) Best Score = 0, Worst Score = 50 Function Score = Sum of the 10 function items, Divided by 2 (out of 50) Best Score = 0, Worst Score = 50 Computing the Total Score Total Score = Sum of pain + function scores Best Score = 0, Worst Score = 100

Time frame: Functional assessment will be performed at 4, 6 and 12 weeks from treatment