Journal Facts

Journal
BoneKEy Reports
ISSN
2047-6396
Volume
2
Year
2013

Article Facts

Title
Ultrasound therapy for fractures: who benefits and who does not?
DOI
10.1038/bonekey.2013.197
Author
Online Date
11/20/2013

Article Links

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Ultrasound therapy for fractures: who benefits and who does not?


DOI:10.1038/bonekey.2013.197

Low-intensity pulsed ultrasound (LIPUS) is beneficial in fresh fractures, but its value in fractures that don’t heal is less clear. Watanabe et al. studied 101 patients with delayed union and 50 with nonunion treated with LIPUS to identify predictable factors that could inform clinicians whether to use LIPUS instead of, or in addition to, surgery.

LIPUS was successful in 74.3% of the delayed unions; factors associated with LIPUS failure were having an atrophic or oligotrophic nonunion (vs. a hypertrophic nonunion), fracture site instability and a maximum fracture gap size of>9 mm. The respective relative risks were 23.72 (95% confidence interval [CI] 1.20–11.5, P<0.01), 3.03 (95% CI 1.67–5.49, P<0.001) and 3.30 (95% CI 1.68–6.45).

Ultrasound therapy proved beneficial in 68% of patients with nonunion; failure was more common in patients who had received intramedullary nail fixation, had fracture site instability and whose maximum fracture gap size was>8 mm. The respective relative risks were 4.50 (95% CI 1.69–12.00, P<0.001), 4.56 (95% CI 2.20–9.43, P<0.0001) and 5.09 (95% CI 1.65–15.67).

Editor’s comment: LIPUS is attractive as a noninvasive technique for delayed and nonunion fractures, but treatment failure is not uncommon. In this cohort evaluation, oligotrophic nonunion, fracture gap>8 mm, fixation with intramedullary nails and instability were predictors of a negative outcome. Excluding these patients may increase the cost-effectiveness of LIPUS and stream appropriate patients to earlier surgery.

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