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Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial

BMJ 2016; 355 doi: (Published 25 October 2016) Cite this as: BMJ 2016;355:i5351

Re: Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial

Dear Sir

I note that in their article on Low intensity ultrasound for fractures of the tibia, Bussell et al conclude that “post-operative use of low intensity pulsed ultrasound after tibial fracture fixation does not accelerate radiographic healing and fails to improve function” ( BMJ 2016;355:i5351).

In my MD Thesis of 1987, I investigated the Effect of Ultrasound on Fracture Repair (University of London).

The effect of ultrasound on fracture repair was investigated by studying the rate of healing of a standard lower tibial osteotomy in three groups of similar New Zealand White rabbits – an untreated group and groups treated with ultrasound and mock ultrasound. Parameters of treatment were an intensity of 0.5 W/cm², and a frequency of 1.5 KHz ( S.A.T.P.) using a pulsed regime (2msec on, 8 msec off) administered for 10 minutes per day, five days a week for four weeks postoperatively. A fracture gap was maintained throughout repair by a specially designed external fixator. Three animals from each group were studied two weekly up to twelve weeks by intra-arterial perfusion with Micropaque. Investigation was by radiography, histology, angiography and densitometry.

To compare the rate of fracture repair between the different groups, a numerical method combining histological and radiological systems, was devised. Statistical analysis of the results showed that treatment of the standard osteotomy with ultrasound did not accelerate the rate of repair across the osteotomy gap.

There was no significant difference in the rate of repair among the three groups and treatment with ultrasound had not changed the rate or repair of the standard osteotomy.

It is of interest that both the above laboratory study in 1987 and the clinical study by Bussell et al in 2016 show that ultrasound has no effect on fracture repair.

This brings into question the advisability and effectiveness of treating fractures with ultrasound.

Yours sincerely

Richard Brueton MA MD FRCS
Honorary Consultant Orthopaedic Surgeon
Royal Free Hospital

Competing interests: No competing interests

01 November 2016
Richard N Brueton
Honorary Consultant Orthopaedic Surgeon