title: The evidence of low-intensity pulsed ultrasound for in vitro, animal and human fracture healing.
abstract: BACKGROUND
  Physical stimulation therapies are currently available to enhance fracture healing.
  
  
  METHODS
  A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords 'ultrasound' and 'fracture healing'.
  
  
  RESULTS
  The evidence in vitro and animal studies suggests that low-intensity pulsed ultrasound (LIPUS) produces significant osteoinductive effects, accelerating the healing process and improving the bone-bending strength.
  
  
  RESULTS
  The evidence in human trials is controversial in fresh, stress fractures and in limb lengthening. LIPUS is effective in delayed unions, in smokers and in diabetic population.
  
  
  CONCLUSIONS
  LIPUS is an alternative, less invasive form of treatment for complicated fractures, in patients with poor bone healing and may play a role in the management of large-scale bone defects producing substantial cost savings and decreasing associated disability.
  
  
  CONCLUSIONS
  There is heterogeneity among in vitro, animal studies and their application to human studies. Further randomized controlled trials of high methodological quality are needed.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, FREMAP Hospital, Ctra de Pozuelo 61, 28220 Majadahonda, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Martinez de Albornoz
authors.forename: Anil
authors.initials: A
authors.lastname: Khanna
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.forename: Francisco
authors.initials: F
authors.lastname: Forriol
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D019317:Evidence-Based Medicine / Q000379:methods; D017102:Fracture Healing / Q000528:radiation effects*; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*