Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis

• Published in: Injury 2017-07, Vol.48 (7), p.1339-1347
• Main Authors: Leighton, Ross, Watson, J. Tracy, Giannoudis, Peter, Papakostidis, Costas, Harrison, Andrew, Steen, R. Grant
• Format: Article
• Language: English
• Subjects: Femur; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Fractures, Bone - physiopathology; Fractures, Bone - therapy; Fractures, Ununited - physiopathology; Fractures, Ununited - therapy; Humans; Humerus; Radius; Randomized clinical trial (RCT); Randomized Controlled Trials as Topic; Scaphoid; Tibia; Time Factors; Treatment Outcome; Ulna; Ultrasonic Therapy - methods
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2017.05.016

Bone fractures fail to heal and form nonunions in roughly 5% of cases, with little expectation of spontaneous healing thereafter. We present a systematic review and meta-analysis of published papers that describe nonunions treated with low-intensity pulsed ultrasound (LIPUS). Articles in PubMed, Ovid MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library, and Scopus databases were searched, using an approach recommended by the Methodological Index for Non-Randomized Studies (MINORS), with a Level of Evidence rating by two reviewers independently. Studies are included here if they reported fractures older than 3 months, presented new data with a sample N≥12, and reported fracture outcome (Heal/Fail). Thirteen eligible papers reporting LIPUS treatment of 1441 nonunions were evaluated. The pooled estimate of effect size for heal rate was 82% (95% CI: 77–87%), for any anatomical site and fracture age of at least 3 months, with statistical heterogeneity detected across all primary studies (Q=41.2 (df=12), p