Intended for healthcare professionals


Adjunctive non-invasive ways of healing bone fractures

BMJ 2009; 338 doi: (Published 27 February 2009) Cite this as: BMJ 2009;338:b11
  1. Rudolf W Poolman, consultant orthopaedic surgeon
  1. 1Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis and Medisch Centrum Jan van Goyen, Postbus 95500, 1090 HM Amsterdam, Netherlands
  1. Poolman{at}

    Moderate to poor quality evidence shows no benefit on clinically important outcomes

    The treatment of bone fractures in the extremities traditionally includes cast immobilisation or surgery using internal or external fixation devices. Adjunctive non-invasive or extracorporal treatments have also been developed to speed up bone healing in people with fractures or osteotomies. These treatments include electromagnetic stimulation, low intensity pulsed ultrasound, and extracorporal shockwave therapy, which are generally referred to as “bone growth stimulators.”

    A recent survey of Canadian orthopaedic surgeons showed that 16% of surgeons reported using bone growth stimulators for managing uncomplicated open and closed tibial shaft fractures and 45% used them for complicated tibial shaft fractures. Surgeons reported using low intensity pulsed ultrasound and electrical stimulation with equal frequency (21% each).1

    In the linked systematic review (doi:10.1136/bmj.b351), Busse and colleagues assess the effectiveness of low intensity pulsed ultrasound for bone …

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