Dementia May Reduce the Effectiveness of Low-Intensity Pulsed Ultrasound (LIPUS) Following Intramedullary Fixation for Trochanteric Fracture of the Femur

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Objectives:Femoral trochanteric fracture often occurs in elderly females with bone fragility, and may accompany the complication of dementia, such as Alzheimer disease. In addition, comminuted fracture and unstable fracture are also confirmed in many cases, but low intensity pulsed ultrasound (LIPUS) is effective in promoting callus formation after osteosynthesis. However, there is a concern that LIPUS may not be effective when dementia develops as a concomitant complication in patients with femoral trochanteric fracture. In this study, we examined the effects of LIPUS to promote callus formation in subjects with and without decreased cognitive function.Subjects and Methods:The inclusion criteria included elderly females who underwent reduction with the use of intramedullary nails of the same type, began to receive load training with no limitation on the day following the surgery, and were followed from surgery to convalescent rehabilitation at our hospital. The exclusion criteria included those who received drugs to increase bone quantity, such as osteoporosis drugs (except for alfacalcidol) and AChEIs, routine steroid administration, or artificial dialysis. The subjects were divided into the decreased cognitive function group with HDS-R of 20 points or less and the non-decreased cognitive function group with 21 points or more. These groups were further divided into the LIPUS treated group and the non-treated group, respectively to compare the appearance of callus confirmed by plain X-ray examination.Results:In the non-decreased cognitive function group, callus formation was significantly promoted by LIPUS, but LIPUS showed no effect in the decreased cognitive function group.Discussions:Patients with dementia, such as Alzheimer disease, exhibit decreased parasympathetic nerve function and decreased bone mass caused by retroplasia of the hypothalamus, as well as protracted synostosis in hip fracture due to dementia. For femoral trochanteric fracture with the complication of decreased cognitive function, concomitant use of LIPUS and AChEIs, which inhibit the aggravation of dementia, may be effective.

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