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Meta-Analysis
. 2009 Feb 27:338:b351.
doi: 10.1136/bmj.b351.

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

Jason W Busse  1 , Jagdeep Kaur, Brent Mollon, Mohit Bhandari, Paul Tornetta 3rd, Holger J Schünemann, Gordon H Guyatt
Affiliations
Meta-Analysis

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

Jason W Busse et al. BMJ. .

Abstract

Objective: To determine the efficacy of low intensity pulsed ultrasonography for healing of fractures.

Design: Systematic review of randomised controlled trials.

Data sources: Electronic literature search without language restrictions of CINAHL, Embase, Medline, HealthSTAR, and the Cochrane Central Registry of Controlled Trials, from inception of the database to 10 September 2008. Review methods Eligible studies were randomised controlled trials that enrolled patients with any kind of fracture and randomly assigned them to low intensity pulsed ultrasonography or to a control group. Two reviewers independently agreed on eligibility; three reviewers independently assessed methodological quality and extracted outcome data. All outcomes were included and meta-analyses done when possible.

Results: 13 randomised trials, of which five assessed outcomes of importance to patients, were included. Moderate quality evidence from one trial found no effect of low intensity pulsed ultrasonography on functional recovery from conservatively managed fresh clavicle fractures; whereas low quality evidence from three trials suggests benefit in non-operatively managed fresh fractures (faster radiographic healing time mean 36.9%, 95% confidence interval 25.6% to 46.0%). A single trial provided moderate quality evidence suggesting no effect of low intensity pulsed ultrasonography on return to function among non-operatively treated stress fractures. Three trials provided very low quality evidence for accelerated functional improvement after distraction osteogenesis. One trial provided low quality evidence for a benefit of low intensity pulsed ultrasonography in accelerating healing of established non-unions managed with bone graft. Four trials provided low quality evidence for acceleration of healing of operatively managed fresh fractures.

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

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Conflict of interest statement

Competing interests: JWB, MB, and GHG are currently involved in a multicentre, randomised controlled trial that has received partial funding from Smith and Nephew, the company that manufactures Exogen. GHG and HJS are members of the GRADE working group.

Figures

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Fig 1 Flow of trials through study. *Two sets of trials reported on common patient samples and were considered as single studies
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Fig 2 Effect of low intensity pulsed ultrasonography on radiographic healing of fractures
See this image and copyright information in PMC

Comment in

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