Low intensity pulsed ultrasonography for fractures: systematic review of randomised controlled trials

doi:10.1136/bmj.b351

Published 27 February 2009, doi:10.1136/bmj.b351
Cite this as: BMJ 2009;338:b351

Research

Low intensity pulsed ultrasonography for fractures: systematic review of randomised controlled trials

Jason W Busse, scientist, assistant professor¹^,2, Jagdeep Kaur, student², Brent Mollon, student³, Mohit Bhandari, associate professor², Paul Tornetta, third, professor⁴, Holger J Schünemann, professor⁵, Gordon H Guyatt, professor²

¹ Institute for Work and Health, Toronto, Canada, ² Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, ³ Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, ⁴ Boston University School of Medicine, MA, USA, ⁵ Unit of Clinical Research Development and INFORMAtion Translation/CLARITY Research Team, Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy

Correspondence to: J W Busse, Institute for Work and Health, 481 University Avenue, Toronto, ON, Canada M5G 2E9 jbusse{at}iwh.on.ca

Objective To determine the efficacy of low intensity pulsedultrasonography for healing of fractures.

Design Systematic review of randomised controlled trials.

Data sources Electronic literature search without language restrictionsof CINAHL, Embase, Medline, HealthSTAR, and the Cochrane CentralRegistry of Controlled Trials, from inception of the databaseto 10 September 2008.

Review methods Eligible studies were randomised controlled trialsthat enrolled patients with any kind of fracture and randomlyassigned them to low intensity pulsed ultrasonography or toa control group. Two reviewers independently agreed on eligibility;three reviewers independently assessed methodological qualityand extracted outcome data. All outcomes were included and meta-analysesdone when possible.

Results 13 randomised trials, of which five assessed outcomesof importance to patients, were included. Moderate quality evidencefrom one trial found no effect of low intensity pulsed ultrasonographyon functional recovery from conservatively managed fresh claviclefractures; whereas low quality evidence from three trials suggestsbenefit in non-operatively managed fresh fractures (faster radiographichealing time mean 36.9%, 95% confidence interval 25.6% to 46.0%).A single trial provided moderate quality evidence suggestingno effect of low intensity pulsed ultrasonography on returnto function among non-operatively treated stress fractures.Three trials provided very low quality evidence for acceleratedfunctional improvement after distraction osteogenesis. One trialprovided low quality evidence for a benefit of low intensitypulsed ultrasonography in accelerating healing of establishednon-unions managed with bone graft. Four trials provided lowquality evidence for acceleration of healing of operativelymanaged fresh fractures.

Conclusion Evidence for the effect of low intensity pulsed ultrasonographyon healing of fractures is moderate to very low in quality andprovides conflicting results. Although overall results are promising,establishing the role of low intensity pulsed ultrasonographyin the management of fractures requires large, blinded trials,directly addressing patient important outcomes such as returnto function.

© Busse et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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