What is the most effective Low-Intensity Pulsed Ultrasound (LIPUS) dose for the augmentation of the rate of healing of non-union fractures? : a systematic review & meta-analysis

Abstract

Introduction: LIPUS has success rates comparable to those of surgery for treatment of nonunion fractures. All studies utilize the same dose approved by the FDA, but employ different duration of treatment (days utilized). The aim of this study is to identify whether the current FDA approved LIPUS dose necessitates adjustment for certain demographic subgroups. Objectives of this study include identifying whether days of LIPUS treatment is associated with an enhanced outcome and analysis of treatment confounding variables in relation to success rate with the current dose. Method: The search strategy string utilized to obtain studies was ((((((fractures, ununited [MeSH Major Topic]) OR fracture*[Title/Abstract]) OR callus[Title/Abstract]) OR bone healing[Title/Abstract]) OR bone remodelling[Title/Abstract]) AND ultraso*[Title/Abstract]). The search engines Pubmed, PEDro, Embase, Cinhal and Cochrane Library were utilized. Citations were gathered utilizing the programme Mendeley©.The Methodological index for Non-Randomized studies (MINORS) scale was utilized for risk of bias and study quality assessment. A meta-analysis was performed utilizing MedCalc©. Study findings: The utilization of IM rods during surgery had the lowest success rate with LIPUS treatment. Patients with minuscule gap sizes, hypertrophic non-unions, and meager NUSS (Non-union scoring system) scores benefit the most from LIPUS treatment. Days since previous surgery, decreased LIPUS treatment duration and fracture age are not associated with a decreased risk of success of non-union healing with LIPUS. Chronic non-unions benefit as much as fresh non-unions from LIPUS treatment. Conclusion: In this systematic review, 81.5 % of patients treated with LIPUS showed healing. With the current dose, certain risk factors have been associated with a negative outcome including utilization of IM rods for fixation and adiposity secondary to attenuation of US.