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Meta-Analysis
. 2017 Sep;96(39):e8181.
doi: 10.1097/MD.0000000000008181.

The effects of low-intensity pulsed ultrasound on fresh fracture: A meta-analysis

Shenghan Lou  1 , Houchen Lv, Zhirui Li, Licheng Zhang, Peifu Tang
Affiliations
Meta-Analysis

The effects of low-intensity pulsed ultrasound on fresh fracture: A meta-analysis

Shenghan Lou et al. Medicine (Baltimore). 2017 Sep.

Abstract

Background: Low-intensity pulsed ultrasonography (LIPUS) is a form of mechanical stimulation that is delivered via a special device to the fracture site for the acceleration of fracture healing. We conducted a meta-analysis to assess the effect of LIPUS for fresh fractures in adults.

Methods: MEDLINE, EMBASE and the Cochrane Library searched between Jan 1980 and Nov 2016. Studies should be quasi-randomized and randomized controlled trials (RCTs) comparing treatment with LIPUS to placebo or no treatment in adults with fresh fractures, reporting outcomes such as function; time to union; delayed union or non-union. Summary standard mean difference (SMD) and the risk ratio (RR) with their 95% confidence interval (CI) calculated with a random effects model. I statistic was used to assess the heterogeneity. Risk of bias was assessed by the Cochrane risk-of-bias tool. The GRADE system was used to evaluate the evidence quality.

Results: A total of 12 trials with 1099 patients were included. The pooled results showed that LIPUS significantly reduced the time to fracture union (SMD: 0.65, 95% CI: 1.13 to 0.17), improved the quality of life (SMD: 0.20, 95% CI: 0.03-0.37) without affecting the time to full weight bearing (SMD: 0.76, 95% CI: 1.92 to 0.4), the time to return to work (SMD: 0.06, 95% CI: 0.14 to 0.27), or the incidence rate of delayed union and nonunion (RR: 1.02, 95% CI: 0.60-1.74).

Conclusions: Moderate-to-high quality evidence shows that LIPUS treatment reduces the time to fracture union and improves the quality of life without affecting functional recovery and incident rate of delayed union and nonunion, suggesting that LIPUS treatment may be a good treatment modality for adults with fresh fractures. However, there are some methodological limitations in the eligible trials, further studies are needed to determine the clinical circumstances under which LIPUS is truly valid and to examine the optimal approach for the use of this adjunctive therapy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram showing the process of literature selection.
Figure 2
Figure 2
Risk of bias graph. Risk of bias summary. “+” means low risk; “?” means unclear risk and “-” means high risk.
Figure 3
Figure 3
Forest plot for the time to fracture union. (A) Operative and conservative management; (B) upper and lower limb; (C) radiological union and clinical union; (D) time less than 6 mo and time until healing.
Figure 4
Figure 4
Forest plot of the quality of life, the time to full weight bearing and the time to return to work. (A) Quality of life; (B) time to full weight bearing; and (C) time to return to work.
Figure 5
Figure 5
Incident rate of delayed union and nonunion. (A) Time less than 6 mo and time until healing; (B) operative and conservative management; and (C) upper and lower limb.
See this image and copyright information in PMC

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