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Dr.Wagner -> ultrasound and fractures (May 22, 2007 2:18:00 AM)
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Ultrasound Treatment May Speed Healing in Fractures
(Elsevier Global Medical News - 05/17/2007)
Mohit Bhandari
QUEBEC CITY (EGMN) - Low-intensity pulsed ultrasound treatment can speed up bone healing by a mean of 64 days and is a reasonable consideration for fresh fractures, according to Dr. Mohit Bhandari, an orthopedic trauma surgeon at McMaster University in Hamilton, Ont.
“There is an absolute demand these days for fast recovery. The urgency is even greater in athletes,” he said at the joint annual meeting of the Canadian Academy of Sport Medicine and the Association Québécoise des Médecins du Sport.
In an earlier meta-analysis of low intensity pulsed ultrasound (LIPUS) for fresh fractures, Dr. Bhandari said he found a faster median time to healing of 30 days for scaphoid fractures, 61 days for distal radius fractures, and 67 days for tibial shaft fractures, compared with controls - and an overall faster median time to healing of 64 days, a clinically significant difference (CMAJ 2002;166:437-41).
In a recent survey of 300 orthopedic surgeons in Canada (submitted for publication by the Journal of Orthopaedic Trauma), a healing time of 30 days was considered clinically important, he said in an interview.
However, Dr. Bhandari noted, published studies evaluating treatment of fractures with ultrasound have been small and their data unconvincing.
As a result, the medical community’s response to LIPUS has been muted. Dr. Bhandari’s recent findings showed that about half of the 300 surgeons used some form of bone-stimulation treatment for difficult fractures: Forty-five percent of them used ultrasound, 45% used electrical stimulation, and the rest used “other.” And another survey, in 2004, showed that 32% of surgeons and 21% of physiotherapy students believed that ultrasound could actually be harmful to healing bones (Arch. Phys. Med. Rehabil. 2004;85:1653-6).
The published evidence in favor of LIPUS applies to fresh, nonoperative fractures, but there also is evidence that ultrasound can be effective in operative treatment, said Dr. Bhandari. He and his fellow researchers are currently enrolling patients for the multinational randomized controlled TRUST study (Trial to Reevaluate Ultrasound in the Treatment of Tibial Fractures) to compare ultrasound and placebo in tibial fractures treated with intramedullary nails.
“We believe there is likely an important effect that previous studies were unable to elucidate due to small sample sizes,” he said of the study, which aims to enroll 500 patients. It is funded by the Canadian Institute of Health Research and Exogen Inc. (Smith and Nephew, United Kingdom). Dr. Bhandari disclosed no business relationship with Exogen, which manufactures a LIPUS device.
He noted that the evidence for ultrasound treatment of nonunions (fractures with delayed healing) was even weaker. “There is some suggestion of benefit with nonunions, but we need more studies to refute or confirm this.”
However, Dr. Nick Mohtadi, an orthopedic surgeon at the University of Calgary (Alta.), emphasized that the evidence would need to be well established because the technology is costly. “The number of nonunions is so small that the market for that type of thing is minimal. But if you’re talking about fresh fractures and healing people earlier, then it’s billions.”
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