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

Busse JW, Kaur J, Mollon B, Bhandari M, Tornetta P, Schünemann HJ, Guyatt GH - BMJ (2009)

Bottom Line: To determine the efficacy of low intensity pulsed ultrasonography for healing of fractures.Two reviewers independently agreed on eligibility; three reviewers independently assessed methodological quality and extracted outcome data.Evidence for the effect of low intensity pulsed ultrasonography on healing of fractures is moderate to very low in quality and provides conflicting results.

View Article: PubMed Central - PubMed

Affiliation: Institute for Work and Health, Toronto, Canada. jbusse@iwh.on.ca

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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Fig 2 Effect of low intensity pulsed ultrasonography on radiographic healing of fractures
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fig2: Fig 2 Effect of low intensity pulsed ultrasonography on radiographic healing of fractures

Mentions: When time to radiographic healing—the most commonly reported end point among eligible trials—was pooled across all studies it showed a moderate effect in favour of low intensity pulsed ultrasonography. The pooled mean reduction in radiographic healing time was 33.6% (95% confidence interval 21.4% to 43.8%) but the associated heterogeneity was high (I2=76.9%; heterogeneity P<0.01; fig 2). Tests of interaction provided no evidence to support a different treatment effect across clinical presentations. The effect of low intensity pulsed ultrasonography was not significantly different between conservatively managed fresh fractures and operatively managed fresh fractures (P=0.48), between conservatively managed fresh fractures and operatively managed non-unions (P=0.61), or between operatively managed fresh fractures and operatively managed non-unions (P=0.39).


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

Busse JW, Kaur J, Mollon B, Bhandari M, Tornetta P, Schünemann HJ, Guyatt GH - BMJ (2009)

Fig 2 Effect of low intensity pulsed ultrasonography on radiographic healing of fractures
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651102&req=5

fig2: Fig 2 Effect of low intensity pulsed ultrasonography on radiographic healing of fractures
Mentions: When time to radiographic healing—the most commonly reported end point among eligible trials—was pooled across all studies it showed a moderate effect in favour of low intensity pulsed ultrasonography. The pooled mean reduction in radiographic healing time was 33.6% (95% confidence interval 21.4% to 43.8%) but the associated heterogeneity was high (I2=76.9%; heterogeneity P<0.01; fig 2). Tests of interaction provided no evidence to support a different treatment effect across clinical presentations. The effect of low intensity pulsed ultrasonography was not significantly different between conservatively managed fresh fractures and operatively managed fresh fractures (P=0.48), between conservatively managed fresh fractures and operatively managed non-unions (P=0.61), or between operatively managed fresh fractures and operatively managed non-unions (P=0.39).

Bottom Line: To determine the efficacy of low intensity pulsed ultrasonography for healing of fractures.Two reviewers independently agreed on eligibility; three reviewers independently assessed methodological quality and extracted outcome data.Evidence for the effect of low intensity pulsed ultrasonography on healing of fractures is moderate to very low in quality and provides conflicting results.

View Article: PubMed Central - PubMed

Affiliation: Institute for Work and Health, Toronto, Canada. jbusse@iwh.on.ca

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.

Show MeSH
Related in: MedlinePlus