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Wu W, Maffulli N, Furia JP, et al. Exposure of zebra mussels to radial extracorporeal shock waves: implications for treatment of fracture nonunions. J Orthop Surg Res. 2021;16(1):707doi: 10.1186/s13018-021-02852-1.
Wu, W., Maffulli, N., Furia, J. P., Meindlhumer, L., Sternecker, K., Milz, S., & Schmitz, C. (2021). Exposure of zebra mussels to radial extracorporeal shock waves: implications for treatment of fracture nonunions. Journal of orthopaedic surgery and research, 16(1), 707. https://doi.org/10.1186/s13018-021-02852-1
Wu, Wenkai, et al. "Exposure of zebra mussels to radial extracorporeal shock waves: implications for treatment of fracture nonunions." Journal of orthopaedic surgery and research vol. 16,1 (2021): 707. doi: https://doi.org/10.1186/s13018-021-02852-1
Wu W, Maffulli N, Furia JP, Meindlhumer L, Sternecker K, Milz S, Schmitz C. Exposure of zebra mussels to radial extracorporeal shock waves: implications for treatment of fracture nonunions. J Orthop Surg Res. 2021 Dec 04;16(1):707. doi: 10.1186/s13018-021-02852-1. PMID: 34863222; PMCID: PMC8642867.
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J Orthop Surg Res. 2021 Dec 04;16(1):707. doi: 10.1186/s13018-021-02852-1.

Exposure of zebra mussels to radial extracorporeal shock waves: implications for treatment of fracture nonunions.

Journal of orthopaedic surgery and research

Wenkai Wu, Nicola Maffulli, John P Furia, Lukas Meindlhumer, Katharina Sternecker, Stefan Milz, Christoph Schmitz

Affiliations

  1. Extracorporeal Shock Wave Research Unit, Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, 80336, Munich, Germany.
  2. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
  3. Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England, UK.
  4. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, E1 4DG, England, UK.
  5. SUN Orthopedics of Evangelical Community Hospital, 210 JPM Rd, Lewisburg, PA, 17837, USA. [email protected].

PMID: 34863222 PMCID: PMC8642867 DOI: 10.1186/s13018-021-02852-1

Abstract

BACKGROUND: Radial extracorporeal shock wave therapy (rESWT) is an attractive, non-invasive therapy option to manage fracture nonunions of superficial bones, with a reported success rate of approximately 75%. Using zebra mussels (Dreissena polymorpha), we recently demonstrated that induction of biomineralization after exposure to focused extracorporeal shock waves (fESWs) is not restricted to the region of direct energy transfer into calcified tissue. This study tested the hypothesis that radial extracorporeal shock waves (rESWs) also induce biomineralization in regions not directly exposed to the shock wave energy in zebra mussels.

METHODS: Zebra mussels were exposed on the left valve to 1000 rESWs at different air pressure (between 0 and 4 bar), followed by incubation in calcein solution for 24 h. Biomineralization was evaluated by investigating the fluorescence signal intensity found on sections of the left and right valves prepared two weeks after exposure.

RESULTS: General linear model analysis demonstrated statistically significant (p < 0.05) effects of the applied shock wave energy as well as of the side (left/exposed vs. right/unexposed) and the investigated region of the valve (at the position of exposure vs. positions at a distance to the exposure) on the mean fluorescence signal intensity values, as well as statistically significant combined energy × region and energy × side × region effects. The highest mean fluorescence signal intensity value was found next to the umbo, i.e., not at the position of direct exposure to rESWs.

CONCLUSIONS: As in the application of fESWs, induction of biomineralization by exposure to rESWs may not be restricted to the region of direct energy transfer into calcified tissue. Furthermore, the results of this study may contribute to better understand why the application of higher energy flux densities beyond a certain threshold does not necessarily lead to higher success rates when treating fracture nonunions with extracorporeal shock wave therapy.

© 2021. The Author(s).

Keywords: Biomineralization; Calcein green; Fracture non-union; Mussel shell; rESWT

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