Ultrasound and Shockwave Therapy for Acute Fractures

Summary

A Cochrane review [Abstract] 1 included 12 studies with a total of 622 subjects (with 648 fractures). The interventions of interest included low intensity ultrasound (LIPUS; 11 studies), high intensity focused ultrasound (HIFUS; no studies) and extracorporeal shockwave therapies (ECSW; 1 study) as part of the treatment of acute fractures in adults. The fractures were either conservatively treated upper limb complete fractures (4 studies), lower limb complete fractures (6 studies, surgically fixed in 4 studies) or conservatively treated tibial stress fractures (2 studies).Nine of the studies were placebo-controlled.

Very limited data from two complete fracture studies showed no difference between ultrasound and placebo control in functional outcome. Pooled estimates from 2 studies found LIPUS did not significantly affect the time to return to training or duty in soldiers or midshipmen with stress fractures (mean difference -8.55 days, 95% CI -22.71 to 5.61).Based on a 'worst case' analysis, which adjusted for incomplete data, pooled results from 8 heterogeneous studies showed no statistically significant reduction in time to union of complete fractures treated with LIPUS (standardised mean difference -0.47, 95% CI -1.14 to 0.20). Pooled results from 8 trials reporting proportion of delayed union or non-union showed no significant difference between LIPUS and control. Adverse effects directly associated with LIPUS and associated devices were found to be few and minor, and compliance with treatment was generally good. One study reporting on pain scores found no difference between groups at 8 weeks.

One quasi-randomised study (59 fractures) found no significant difference between ECSW and no-placebo control groups in non-union at 12 months (risk ratio 0.56, 95% CI 0.15 to 2.01). There was a clinically small but statistically significant difference in the visual analogue scores for pain in favour of ECSW at three month follow-up. The only reported complication was infection, with no significant difference between the two groups.