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New device for hard to heal bone fractures
NICE supports the NHS use of an ultrasound bone healing system
9th January 2013 - The National Institute for Health and Clinical Excellence (NICE) has published new guidance supporting the use of an ultrasound device to heal fractured bones.
It advises that the EXOGEN bone healing system benefits patients, and the NHS, when used for treating long bone fractures that haven't healed after nine months.
EXOGEN delivers low-intensity pulsed ultrasound waves that aim to promote bone healing through stimulating the production of growth factors and proteins which increase the removal of old bone and increase the production of new bone. Long bone fractures are suitable for treatment if the fracture is stable and well-aligned.
Ultrasound waves are delivered straight to the fracture site via a small transducer which is secured by a strap. For patients wearing a cast, a hole is cut to allow the transducer to make contact with the skin at the fracture site.
The device is programmed to deliver ultrasound in 20-minute sessions which the patient uses the device each day at home.
Failure to heal after nine months
NICE says treating bone fractures that have failed to heal after nine months (non-union fractures) using EXOGEN show a high rates of fracture healing. It estimates it saves the NHS £1,164 per patient by avoiding surgery.
Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, says in a media release: "We are pleased to publish final medical technology guidance which supports the use of EXOGEN for treating long bone fractures which have not healed after nine months. NICE’s independent Medical Technologies Advisory Committee (MTAC) considered that there was evidence to show that using the device in this situation resulted in high rates of fracture healing."
Failure to heal after three months
However, the case for using EXOGEN routinely for long bone fractures with delayed healing wasn’t supported by NICE because of uncertainties in the evidence.
Professor Longson says: "Whilst there is some evidence that EXOGEN can improve healing in fractures which have not healed after three months, there are uncertainties about the rate at which this healing progresses and whether or not surgery would be required. Because of these uncertainties, the modelling of the cost consequences was complex, and the case for the NHS routinely adopting EXOGEN for fractures which had not healed after just three months could not be supported.
"We hope that this guidance will be useful for NHS staff providing treatment for people with long bone fractures that have failed to heal after nine months."