title: Low-intensity pulsed ultrasound in the treatment of nonunions.
abstract: BACKGROUND
  Low-intensity ultrasound has demonstrated an acceleration of bone healing and more profound callus formation in animal and human clinical experiments. In this study, the effect of pulsed, low-intensity ultrasound was determined in established nonunion cases.
  
  
  METHODS
  The enrolled cases were reviewed for the time from their last surgical procedure and evidence of no healing or progression of healing during the 3 or more months before the start of low-intensity ultrasound therapy to determine whether the cases were established nonunions. Twenty-nine cases, located in the tibia, femur, radius/ulna, scaphoid, humerus, metatarsal, and clavicle, met the criteria for established nonunions. On average, the postfracture period before the start of ultrasound treatment was 61 weeks. Initial fracture treatment was conservative in 8 cases and operative in 21 cases. Additional treatments including bone grafting, reosteosynthesis, and other surgical procedures were performed an average of 52 weeks before the start of ultrasound treatment. Daily, 20-minute applications of low-intensity ultrasound at the site of the nonunion were performed by the patients at home.
  
  
  RESULTS
  Twenty-five of the 29 nonunion cases (86%) healed in an average treatment time of 22 weeks (median, 17 weeks). Stratification of the healed and failed outcome for age, gender, concomitant disease, bone location, fracture age, prior last surgery interval, nonunion type, smoking habits, and fixation before and during treatment showed a significant difference only in the smoking habit strata.
  
  
  CONCLUSIONS
  Noninvasive ultrasound therapy can be useful in the treatment of challenging, established nonunions.
authors.affiliation: Department of Orthopaedics, Academic Medical Center, University of Amsterdam, The Netherlands. panolte@knmg.nl
authors.forename: P A
authors.initials: PA
authors.lastname: Nolte
authors.forename: A
authors.initials: A
authors.lastname: van der Krans
authors.forename: P
authors.initials: P
authors.lastname: Patka
authors.forename: I M
authors.initials: IM
authors.lastname: Janssen
authors.forename: J P
authors.initials: JP
authors.lastname: Ryaby
authors.forename: G H
authors.initials: GH
authors.lastname: Albers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D003131:Combined Modality Therapy; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014464:Ultrasonic Therapy / Q000379:methods; D014463:Ultrasonography