This article is more than 5 years old. Information may no longer be current.
Study supports low-intensity pulsed ultrasound for treatment of fracture nonunions
Click Here to Manage Email Alerts
Findings from this systematic review and meta-analysis indicated low-intensity pulsed ultrasound may be a viable alternative treatment for fracture nonunions.
“[There] is documented efficacy and benefit shown when [low-intensity pulsed ultrasound] LIPUS treatment is used as an alternative to surgery for established nonunions,” study coauthor J. Tracy Watson, MD, told Healio.com/Orthopedics. “With a strict definition of nonunion reviewed, the rate of healing approached 84%. This modality was shown to be most effective when used on hypertrophic nonunions and when this treatment was initiated as soon as the last surgical procedure was deemed unsuccessful in achieving union. LIPUS treatment may be useful in those patients for whom surgery is high risk.”
Watson and colleagues used an approach recommended by the Methodological Index For Non-randomized Studies to search PubMed, Ovid Medline, Cinahl, Amed, Embase, Cohrane Library and Scopus databases. They found 13 articles that discussed a total of 1,441 fracture nonunions treated with LIPUS.
Findings showed a 82% pooled estimate of effect size for the heal rate for any anatomical nonunion site with a fracture aged at least 3 months. Investigators noted when a “stricter” definition of nonunion with a fracture age of 8 months or more was considered, the pooled estimate of effect size for the heal rate was 84%.
According to researchers, hypertrophic nonunions compared with inactive atrophic nonunions had twice the chance of healing.
“An interval of without surgery of [less] than 6 months prior to LIPUS was associated with a more favorable result,” the researchers wrote.
Heal rates in upper extremity, long bone nonunions and lower extremity, long bone nonunions were not statistically significantly different. – by Monica Jaramillo
Disclosures: Leighton reports he is a paid consultant for Bioventus. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to Top
William M. Ricci, MD
Low-intensity pulsed ultrasound (LIPUS) is controversial for the treatment of nonunions. It has been studied for more than 2 decades without clear consensus regarding its utility. The study by Leighton and colleagues is an attempt to shed light on this topic by compiling results from numerous studies using sophisticated meta-analysis methods. Analysis of 13 of the best available studies that included 1,441 nonunions found LIPUS can result in an increased healing rate for nonunions, especially those between 3 months and 6 months from last surgery and those that are hypertrophic. The overall success rate of LIPUS was 80%.
This study adds further indirect evidence supporting LIPUS for the treatment of nonunions. The authors, however, concede that a randomized controlled trial should be conducted as none currently exist. Unfortunately, such a study is unlike to occur due to financial and logistical considerations. Surgeons are therefore left with LIPUS as one arrow in their quiver for treating patients with nonunion. There is no evidence, to my knowledge, that LIPUS is in any way harmful.
As the authors point out, LIPUS should be considered for any patient with a hypertrophic nonunion between 3 months and 6 months old. In my practice, LIPUS is ideal when these conditions are met and surgery is undesirable (for any reason) and/or when the level of patient disability will be minimal during the LIPUS treatment duration. Conversely, when patients are severely disabled or in considerable pain from nonunion motion, it may be more compassionate to provide fracture stability with surgery regardless of the efficacy of LIPUS.
Click Here to Manage Email Alerts