Information for doctors
The mechanism of action
The sonication of a fracture site with Melmak® Ultrasound1 promotes calcification of the callus tissue at the affected site.
During the daily 20-minute treatment, 360 million mechanical impulses with a force of 0.030 grams hit the fracture site. They create oscillation of the cell walls of the mesenchymal cells. As a result, the mesenchymal cells proliferate and differentiate into osteoclasts or osteoblasts under the influence of the parathyroid hormone.
Low-intensity pulsed Melmak ultrasound also stimulates the opening of the calcium channels of osteocytes and increases calcium uptake.2
1 Average sound intensity I = 30 mW/cm² (SATA) (± 30%), sine waves of frequency F = 1.5 MHz (± 5%), signal pulse duration 200 μs (± 10%), repetition rate 1 kHz (± 10%), effective radiating area 3.88 cm², time-related average power 117 mW
2 Siska P., Gruen G. S., Menzel C., Pape H. C., External adjuncts to enhance fracture healing: What is the role of ultrasound? Injury, Int. J. Care Injured (2008) 39, 1095—1105, cited on page 1098 Parvizi et al (1997), Low intensity ultrasound increases intracellular concentration of calcium in chondrocytes, Trans
Indications
Fresh fractures
Fresh fractures 2 4 to support complete healing
Delayed fracture healing
As a conservative treatment method for delayed fracture healing 1 5 6
Pseudarthroses
Pseudarthroses 3 5
1 Haller, P., Nunag, P., Papadopoulos, A., 2023. Low-Intensity Pulsed Ultrasound Treatment for Non-unions of Long Bone Fractures in a Scottish District General Hospital. Cureus 15, e34159. https://doi.org/10.7759/cureus.34159
2 Leung, K.-S., Lee, W.-S., Tsui, H.-F., Liu, P.P.-L., Cheung, W.-H., 2004. Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound. Ultrasound Med Biol. 30, 389-395. https://doi.org/10.1016/j.ultrasmedbio.2003.11.008
3 Nolte, P.A., van der Krans, A., Patka, P., Janssen, I.M., Ryaby, J.P., Albers, G.H., 2001. low-intensity pulsed ultrasound in the treatment of nonunions. J. Trauma 51, 693-702; discussion 702-703. https://doi.org/10.1097/00005373-200110000-00012
4 Nolte P, Anderson R, Strauss E, Wang Z, Hu L, Xu Z, Steen RG, 2016 Heal rate of metatarsal fractures: A propensity-matched study of patients treated with low-intensity pulsed ultrasound (LIPUS) vs. surgical and other treatments. Injury. 2016 Nov;47(11):2584-2590. doi: 10.1016/j.injury.2016.09.023. Epub 2016 Sep 13. http://dx.doi.org/10.1016/j.injury.2016.09.023
6 Pretorius, J., Barry, M., Fadul, A., Murphy, C.G., 2022. Low-Intensity Pulsed Ultrasound Therapy in Patients With Post-traumatic Delayed Union and Non-union. Cureus 14, e32267. https://doi.org/10.7759/cureus.32267
6 Teoh, K.H., Whitham, R., Wong, J.F., Hariharan, K., 2018. The use of low-intensity pulsed ultrasound in treating delayed union of fifth metatarsal fractures. Foot Edinb. Scotl. 35, 52-55.
Contraindications
Do not treat with Melmak ultrasound or only after prior consultation with your attending physician in the case of
- Cancer
- Children/adolescents whose skeleton is not yet fully grown (epiphyseal plate)
- Fractures of the skull or spinal column
- Pacemakers or similar
- Pregnancy
The treatment
The patients perform the treatment of their fractures on their own
- after instruction by the Melmak medical product consultant.
- The fracture site is treated with ultrasound for 20 minutes a day.
- Multiple treatments are possible for complex fractures.
The treatment site
- should, if possible, be marked by the doctor, or
- be clearly identifiable on the basis of X-ray images, scars or similar.
Sonication and metal implants (no heat is generated)
- Metal implants are not a contraindication for Melmak ultrasound treatment!
- As the ultrasound is pulsed, there is no thermal effect, i.e. nails and screws are not a problem. It should be noted that plates reflect the ultrasonic waves. In this case, the fracture site must be sonicated parallel to the plate or from the opposite side.
Reprints of the articles from "Der Unfallchirurg" (2009 and 2020) on this topic (only in German) as well as studies and further information are available free of charge from Melmak.
Information material
We offer you the opportunity to request a summary of the most important studies from us, free of charge of course ...
