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Letters Low intensity pulsed ultrasound for bone healing

Authors’ reply to Farrar

BMJ 2017; 356 doi: (Published 24 March 2017) Cite this as: BMJ 2017;356:j1483
  1. Stefan Schandelmaier, methodologist1,
  2. Reed A C Siemieniuk, methodologist1,
  3. Thomas Agoritsas, assistant professor1,
  4. Per O Vandvik, associate professor2,
  5. Gordon H Guyatt, distinguished professor1,
  6. Jason W Busse, associate professor1
  1. 1Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
  2. 2Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
  1. schandes{at}

Farrar questions the finding of our systematic review—that low intensity pulsed ultrasound (LIPUS) was not effective12—based on two hypotheses. Firstly, that despite being ineffective in fresh fractures, LIPUS may work in non-union fractures and, secondly, that its effectiveness is dose dependent.

Our systematic review included three trials that enrolled patients with non-union of a fracture, all of which were at high risk of bias, and none reported outcomes that are important to patients. We …

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