Abstract
BackgroundNon-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Low intensity pulsed ultrasound (LIPUS) is a non-invasive therapy for non-union treatment that can improve the long-term outcome. The purpose of this study is to summarize the available literature assessing LIPUS potential to improve the union rate in instrumented, infected, and fragility non-unions.MethodsA literature search was conducted in the MEDLINE, EMBASE, and CINAHL databases for all relevant literature on the healing rates of LIPUS utilized in instrumented, infected, and fragility non-unions. Study characteristics were summarized for each of the included studies. The percentage of healed patients (healing rate), for instrumented, infected, and fragility fracture non-union patients were pooled from each included study.ResultsThe literature search identified a total of 326 articles, while searching reference lists and grey literature identified an additional 3 articles. There was a total of 29 articles included in this review, with 20 articles included within the quantitative synthesis of healing rates. The most common design of included studies was case series (17 articles), followed by case reports (9 articles). Studies were primarily retrospective (18 studies), with an additional 10 prospective studies. Non-union healing rates were 82% (95% CI: 76 to 87%) in instrumented, 82% (95% CI: 70 to 95%) in infected, and 91% (95% CI: 87 to 95%) in fragility fracture patients with non-unions.ConclusionThis study has provided a thorough overview of the current literature on LIPUS treatment for instrumented, infected, and fragility fracture non-unions. The healing rates for non-unions in these subgroups were comparable to healing rates observed with LIPUS use in general non-union literature. LIPUS treatment should be considered as a conservative non-surgical treatment option to potentially reduce the socioeconomic impact and improve the quality of life of these unfortunate patients.Level of evidence4 (systematic review of primarily case series data)
Highlights
Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal
These non-union subgroups are associated with increased risks of further complications, which can increase the socioeconomic impact to the patient and their families
These findings support the use of Low intensity pulsed ultrasound (LIPUS) for conservative non-union management within these non-union subgroups, as these healing rates are similar to those seen for LIPUS use within the general non-union literature [38]
Summary
Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Non-unions have a significant impact on the quality of life of patients due to a need for further interventions, which is often additional surgery. Estimates suggest that the cost of non-union management is $25,556 per patient, with increased need for opioids, and substantial increased use of the health care system [5]. Non-unions that occur in instrumented, fragility fractures, or infected fractures can be challenging to manage [6, 7]. These non-union subgroups are associated with increased risks of further complications, which can increase the socioeconomic impact to the patient and their families. Avoiding the need for additional surgery through conservative management of nonunions can have a substantial benefit to patients and the healthcare system alike, if the nonunion can be resolved nonoperatively
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