Krishang was 13 years old when he sustained fracture of lower end of Humerus ( Arm bone). Like any other child he underwent standard procedure of fracture fixation as the fracture was widely displaced. 2 years back in May 2019, when I attended Master Krishang in Accident & Emergency department I never expected that the fracture of this bone would behave unusual.
The next day Krishang’s fracture was fixed with a plate and screws and the surgery went well. He was discharged after 2 days and was regularly following up in OPD. I was happy with the progress of Krishang’s rehabilitation and the fracture healing. He started using his arm and carrying out his daily activities. At 6 months follow up I was surprised to notice that the healing is not progressing further and bone union is yet to complete. This usually doesn’t happen in children as the fracture healing is very fast due to robust blood supply and thick periosteum (a layer of sheath that protects & covers the bone). However, Krishang was doing well and he was asymptomatic. I decided to wait and give the physiology of his body to act at its pace but at the same time I was deeply thinking and seeking all the answers to the probable causes for hindering the fracture union process in this case. To my surprise Krishang presented with another fracture of same bone at different level but this time it was on opposite side. This fresh fracture was a clue to all my questions which I was asking myself what could be the reason of his previous fracture not healing in time. In spite of giving bone strengthening medication Krishang continued to sustain a fresh fracture, and his body took longer time to complete the union of the fractured bone for which he underwent surgery. The recent fracture was near to the growing end of the bone and was managed conservatively with a plaster cast.
At about 9 months post surgery I discussed with Krishang’s parents that it is the time to intervene to accelerate the fracture union. They were very cooperative and they rested the appropriate decision in my hands for the good cause. I explained them about the LIPUS ( Low Intensity Pulsed Ultrasound ) therapy. They immediately agreed and gave the consent to proceed.
Ultrasound bone healing is a safe and non-invasive that accelerates the healing of a fractured bone. This is based on Wolf’s law that “mechanical stress is responsible for determining the architecture of the bone”. LIPUS accelerates the healing of the fractured bone by mechanical stimulation caused by ultrasound thereby increasing the blood supply to the fractured site. This method and device is commonly used in Japan for delayed healing of fractured bones. It was used for the first time in India by me (Dr.Basa) at Kokilaben hospital, Mumbai. I discussed this case with doctors in Japan using this method and fortunately the device which was earlier unavailable was available in India at that time. I grabbed the opportunity, went through the legal procedures and started using it on Krishang’s bone. Amidst of Covid-19 Pandemic the company executives cooperated and did the needful. In spite of all hindrances LIPUS was instituted and following X-rays showed satisfactory results. Finally in 6 months the fracture united completely and Krishang successfully underwent the plate & screws removal in May 2021.
I sincerely thank Krishang & his parents for their patience & having faith in me. I extend my gratitude to Dr.Titebe from Japan for his timely guidance and the team of Accellus Sigmax for their cooperation.
Indeed I must say I have learnt a lot through this case.!