Use Of Low-Level Laser Therapy In Conservative Treatment Of Delayed Union Of Human Upper And Lower Limb Fractures

摘要

Objective: The current clinical case series assesses the early clinical outcome of the use of low-level laser in the treatment of delayed union of upper and lower extremity fractures.Materials and Methods: The patient cohort consisted of 17 consecutive unselected patients with delayed union. All patients refused operations. All subjects were given functional Sarmiento brace, together with low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases.Results: All patients had solid union, mean time for union for upper and lower limb fractures were 7 and 10 weeks respectively. The two non-responders include one patient who refused to come for follow up treatment and another who was non-compliant with splint wear The calculated p value was statistically significant at p < 0.05.Conclusion: LLLT markedly shortens the healing time and can be used in treating upper and lower limbs fractures with delayed union. Introduction Delayed union, by definition, in general occurs when there are no signs of bony healing or a delay in bony union of the fracture ends after an adequate period of time had elapsed. In other words, a solid union is not detected within an expected time frame. The exact timing varies according to age, the bony part involved, and extent of soft tissue injury. Traditionally, many clinicians would consider operative intervention in the face of a delayed union. However, not every patient consents for an operative intervention. In such scenarios, we as clinicians still need to seek ways to enhance bony healing using non-invasive methodologies as this group of patients dislikes the idea of invasive intervention or operative intervention.The use of low-level laser therapy in promoting fracture healing of human fractures had previously been reported by the author [1] and also from clinicians in Taiwan [2]. This study represents the first ever study to assess the clinical use of LLLT in the conservative treatment of delayed fracture union of human upper and lower extremity fractures.Advantages of the use of LLLT in delayed fracture union is manifold. Firstly, the procedure is non-invasive and spares the patient an operative intervention. Operative intervention in general not only involves higher cost, but also it leaves the patient with a surgical scar and complications sometimes occur after an operation for delayed union such as infection or failure of metallic implants. In addition, a second operation is often required for removal of the metallic implant in younger subjects. The mean age of the patient population is relatively young in the current study. If a subsequent study reveals the same clinical efficacy in the elderly, this would be an extra advantage since older patients have in general a higher operative risk. Secondly, the world literature on LLLT showed it is free of side effects and has been in use in Europe over 30 years. Thirdly, LLLT administration does not involve higher costs with the average cost of administration per session being same as conventional physical therapy in the author’s institute. It should be noted that conventional physical therapy machines do not have bio-modulation effects as does LLLT [3] and thus cannot in effect promote the process of fracture healing. Materials and methods The study population consisted of a series of consecutive unselected 17 patients with a mean age of 26 (range 9 to 39) presenting with clinical delayed union of an upper or lower limb fracture. All of the patients had had not less than 6 weeks of casting done in other medical units but there was inadequate bony healing response on serial radiological assessments. All patients who entered the study refused operative intervention which represented the main pre-requisite for study entry and all consented for the use of LLLT as well as Sarmiento functional bracing as the sole treatment modality. Other exclusion criteria included history of psychiatric