X-ray image of a human shoulder highlighting inflammation or possible injury around the glenohumeral joint, with red shading indicating the affected area.

Dr Andrew Harrison – Fracture Management – Injury Rehab Network

The first of two Injury Rehab Network events in June with BASRaT featured a presentation from Dr Andrew Harrison, Senior Director of International Medical Affairs, Bioventus. The online event took place on the evening of Monday 2nd June with 200 sports rehabilitation practitioners in attendance.

Andrew discussed Fracture Management. The recording is available to watch here.

Dr Andrew Harrison

Senior Director of International Medical Affairs, Bioventus

Andrew Harrison is a doctoral scientist who gained his PhD at the University of Manchester, focusing on the biology of mesenchymal stem cells. He has spent the past 35 years in orthopaedic R&D.

For the last 21 years, he has researched the mechanism of action and clinical data of the low-intensity pulsed ultrasound (LIPUS) device, known as Exogen.

Fracture Management

$An x-ray image showing a shoulder fracture$

He discussed clinical data, including accelerated fracture repair, treatment of recalcitrant non-unions, and the use of Exogen in a high-performance athlete to enable a return to training as quickly as possible following a fracture. The science behind Exogen’s clinical results was also reviewed, with consideration given to its use in patients with comorbidities, such as diabetes.

Introduction

Dr Harrison discussed his experience in medical research which spans over 30 years and has focused on orthopaedic medicine.

Exogen

Background was provided on Exogen and how it uses Low Intensity Pulsed Ultrasound for the treatment of non-invasive osseous defects. Exogen is approved in the UK, EU, Australia and New Zealand for treatment including:

Delayed unions and nonunion
Accelerating the time to heal fresh fractures
Stress fractures
Accelerating repair following osteotomy
Accelerating repair in bone transport procedures
Accelerating repair in distraction osteogenesis procedures
Joint fusion

Acceleration of acute fractures

Research findings into Exogen show that it can speed up repair by 30%. While the majority of studies have shown positive results, a small number have shown limited outcomes.

FDA non-union evidence was presented, showing an 86% success rate in an average of 4 ½ months, with no safety concerns. NICE Guidance supports the use of Exogen for long bone fractures with non-union or delayed healing.

Exogen Mode of Action

Exogen uses Low Intensity Pulsed Ultrasound (LIPUS) to activate cells, with PGE2 produced by the cell providing the clinical effect. A simple calendar feature supports daily treatment. The device causes nano motion to stimulate integrin production. This encourages cells to react and cluster, forming focal adhesion. 20 minutes use once-a-day treatment has a 24-hour effect.

The target of this signalling is the production of COX2 by primary osteoblasts – COX2 being the rate-limiting enzyme in the production of prostaglandin E2 (PGE2).

Effects considered include:

Significantly increased rate of fracture healing
Activation of new bone formation
Increased cortical bone removal

Research papers about Exogen are available from the links below:

Risk Factors: Diabetes

The challenges faced by diabetic patients were outlined – lower limb fractures can take more than twice as long to heal. With Exogen, the healing rate in patients with diabetes is over 95%.

B.O.N.E.S Studies

The B.O.N.E.S study was discussed, in which patients were prescribed Exogen. The study end point was the 9-month fracture non-union rate. Results were positive for scaphoid and 5th metatarsal non-union cases.

Case Study

A case study was presented about Magnus Moan, a 33-year-old Nordiccombined skier who sustained a stress fracture of the calcaneus while preparing for the World Cup. Although surgery was initially recommended, he opted for Exogen treatment.

Magnus was able to begin treatment without interrupting training and continued cross-country skiing using a specialist treadmill. The fracture healed after 16 weeks, allowing him to compete in the World Cup and secure silver and bronze medals. Watch his story.

How to get the best from Exogen

Dr Harrison’s advice for achieving the best results from Exogen included:

Use Exogen on a stable fracture
Use Exogen on fracture’s with a gap of less than 10mm
Ensure appropriate placement of the transducer
Treatment should be compliant (twenty minutes every day)

Exogen is available on prescription. Future developments were also mentioned, including engineering updates and new applications.

Further information

Find out more about Bioventus and Exogen from the links below:

Q&A

Andrew kindly answered questions put forward by practitioners who attended the session. You can see the presentation recording here.

Presentation Recording

The recording of Andrew’s presentation is available to watch here.

2025 Injury Rehab Network events

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2025

Please enter your details into the form below along with any questions or comments and a member of our team will be happy to provide you with more information:

Dr Andrew Harrison – Fracture Management – Injury Rehab Network