title: Low intensity pulsed ultrasonography for fractures: systematic review of randomised controlled trials.
abstract: OBJECTIVE
  To determine the efficacy of low intensity pulsed ultrasonography for healing of fractures.
  
  
  METHODS
  Systematic review of randomised controlled trials.
  
  
  METHODS
  Electronic literature search without language restrictions of CINAHL, Embase, Medline, HealthSTAR, and the Cochrane Central Registry of Controlled Trials, from inception of the database to 10 September 2008. Review methods Eligible studies were randomised controlled trials that enrolled patients with any kind of fracture and randomly assigned them to low intensity pulsed ultrasonography or to a control group. Two reviewers independently agreed on eligibility; three reviewers independently assessed methodological quality and extracted outcome data. All outcomes were included and meta-analyses done when possible.
  
  
  RESULTS
  13 randomised trials, of which five assessed outcomes of importance to patients, were included. Moderate quality evidence from one trial found no effect of low intensity pulsed ultrasonography on functional recovery from conservatively managed fresh clavicle fractures; whereas low quality evidence from three trials suggests benefit in non-operatively managed fresh fractures (faster radiographic healing time mean 36.9%, 95% confidence interval 25.6% to 46.0%). A single trial provided moderate quality evidence suggesting no effect of low intensity pulsed ultrasonography on return to function among non-operatively treated stress fractures. Three trials provided very low quality evidence for accelerated functional improvement after distraction osteogenesis. One trial provided low quality evidence for a benefit of low intensity pulsed ultrasonography in accelerating healing of established non-unions managed with bone graft. Four trials provided low quality evidence for acceleration of healing of operatively managed fresh fractures.
  
  
  CONCLUSIONS
  Evidence for the effect of low intensity pulsed ultrasonography on healing of fractures is moderate to very low in quality and provides conflicting results. Although overall results are promising, establishing the role of low intensity pulsed ultrasonography in the management of fractures requires large, blinded trials, directly addressing patient important outcomes such as return to function.
authors.affiliation: Institute for Work and Health, Toronto, Canada. jbusse@iwh.on.ca
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Jagdeep
authors.initials: J
authors.lastname: Kaur
authors.forename: Brent
authors.initials: B
authors.lastname: Mollon
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D016025:Bone Transplantation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D010012:Osteogenesis / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*