Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series.

Kavyansh Bhan,Sucheta Sharma,Mahesh Pimplé,Mhafrin Basta,Ronak Patel,Varsha Nandwana,Kamrul Hasan

doi:10.7759/cureus.17067

Abstract

The incidence of nonunion of fractures has been steadily rising owing to improved life expectancy following severe injuries along with rising cases of polytrauma. Once a nonunion is established, the chances of spontaneous healing are deemed to be quite low. Fracture nonunion continues to be a challenge in clinical practice with nonunions having a considerable impact on patient’s quality of life causing both functional and psychosocial disability. Low-Intensity Pulsed Ultrasound (LIPUS) therapy is being projected as a viable and non-interventional alternative to surgical management of nonunions and delayed unions. LIPUS therapy is being widely recommended as a standalone treatment option for the treatment of established nonunions and delayed unions as it is believed to promote healing in all phases of fracture healing viz., inflammatory, intramembranous ossification, chondrogenesis, endochondral ossification and remodelling. In the current scenario of varying results and unclear clinical role of LIPUS therapy, we present a prospective case series of fracture nonunions and delayed unions treated with LIPUS therapy at a large District General Hospital.

Highlights

The incidence of nonunion of fractures varies between 5-10% and has been steadily rising owing to improved life expectancy following severe injuries [1]
In the current scenario of varying results and unclear clinical role of Low-Intensity Pulsed Ultrasound (LIPUS) therapy, we present a prospective case series of fracture nonunions and delayed unions treated with LIPUS therapy at a large District General Hospital
Our series demonstrates a success rate of 78.57% with the use of LIPUS therapy in the treatment of nonunion or delayed union. This is in line with the success rates that have been reported in the current literature

Summary

Introduction

The incidence of nonunion of fractures varies between 5-10% and has been steadily rising owing to improved life expectancy following severe injuries [1]. The first evidence of the use of ultrasound in the treatment of fracture nonunions can be traced to 1983 wherein success rates of almost 70% were reported following the use of ultrasound therapy in established nonunions [8]. LIPUS is being widely considered as a viable treatment option for nonunions and delayed unions in individuals who are not ideal candidates for surgery [11]. This includes patients who are suffering from dementia, old age, multiple organ failure, and coma [11]. Zura et al in their large observational cohort study of 767 patients reported a radiographic union rate of 80% in established nonunions where LIPUS was used as a standalone treatment modality without any adjuncts [13]

Methods

Results

Discussion

Conclusion