title: Low-intensity pulsed ultrasound for non-union treatment: a 14-case series evaluation.
abstract: BACKGROUND
  Non-union is presently managed exclusively by surgery, but alternative treatments are under evaluation.
  
  
  OBJECTIVE
  To assess the benefit of external ultrasound stimulation in surgically treated lowerlimb long-bone non-union.
  
  
  METHODS
  A retrospective series of 14 patients were treated using the Exogen(®) ultrasound stimulator (Smith & Nephew Inc., Memphis, TN, USA) as part of management of surgically treated long-bone non-union. They received 20min stimulation daily over a period of 3 months. Regular clinical and radiological follow-up checked treatment efficacy.
  
  
  RESULTS
  The mean interval to initiation of Exogen(®) treatment after initial surgery was 361 days (range, 6, 38 months). Bone consolidation was obtained in 11 of the 14 cases (79%), and within 3 months of initiation of Exogen(®) treatment in 27% (3/11), within 6 months in 27% (3/11) and within 9 months in 46% (5/11). There were no treatment-linked complications. There was no significant correlation between interval to initiation of ultrasound treatment and bone consolidation. Associated sepsis or atrophy did not significantly impact treatment efficacy.
  
  
  CONCLUSIONS
  The reference treatment strategy in non-union is surgical revision, with consolidation rates ranging from 85 to 100% according to the series. This attitude entails risk of complications, notably infection and postoperative pain. The present results were comparable to those of the literature, with 79% bone consolidation and no complications. Ultrasound stimulation proved an effective and non-invasive treatment for non-union.
  
  
  METHODS
  Retrospective study, level IV.
authors.affiliation: Orthopedic and Traumatologic Surgery Dept, Maison Blanche Hospital, Reims University Hospital, 45, rue Cognacq-Jay, 51100 Reims, France. xavhemery@gmail.com
authors.forename: X
authors.initials: X
authors.lastname: Hemery
authors.forename: X
authors.initials: X
authors.lastname: Ohl
authors.forename: R
authors.initials: R
authors.lastname: Saddiki
authors.forename: L
authors.initials: L
authors.lastname: Barresi
authors.forename: E
authors.initials: E
authors.lastname: Dehoux
mesh_terms: D000293:Adolescent; D000328:Adult; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D005500:Follow-Up Studies; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult