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Pulsed ultrasound for fracture healing

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Some fractures have delayed healing or nonunion. Ultrasound has been suggested as a possible therapeutic agent to improve healing. Does it work? A new systematic review and meta-analysis shows how little evidence we have [1].

Search


This was impressive, using many databases and attempts to find unpublished material, plus hand searching key journals. Methods used were great, and clearly defined inclusion criteria were random allocation to pulsed ultrasound or control, skeletally mature patients, double blinding, with time to radiological healing as the main outcome.

Results


There were three trials involving 158 fractures (tibial shaft, distal radius and scaphoid, respectively). The mean times to healing are shown in Figure 1. Mean healing time was reduced by about 60, 40 and 20 days respectively.

Figure 1: Healing time with ultrasound and placebo



Comment


The authors are justifiably cautious in their conclusions. They say that pulsed ultrasound may reduce time to fracture healing for fractures treated nonoperatively. They imply that we should beware because of the small amount of data. And the trials are good, with high quality scores, so this isn't like some reviews with small amounts of poor information that ladle on heaps of weasel word sauce.

What we frequently lack in systematic reviews is some idea of how much information we need to be sure of the result. If there is little information, as here, then unpublished negative trials could be very important. Someone will be selling this to you soon on the basis that it is "evidence-based"!

Reference:

  1. JW Busse et al. The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis. Canadian Medical Association Journal 2002 166: 437-441.
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