title: Low-intensity pulsed ultrasound does not influence bone healing by distraction osteogenesis: a multicentre double-blind randomised control trial.
abstract: OBJECTIVE
  The aim of this double-blind prospective randomised controlled trial was to assess whether low intensity pulsed ultrasound (LIPUS) accelerated or enhanced the rate of bone healing in adult patients undergoing distraction osteogenesis.
  
  
  METHODS
  A total of 62 adult patients undergoing limb lengthening or bone transport by distraction osteogenesis were randomised to treatment with either an active (n = 32) or a placebo (n = 30) ultrasound device. A standardised corticotomy was performed in the proximal tibial metaphysis and a circular Ilizarov frame was used in all patients. The rate of distraction was also standardised. The primary outcome measure was the time to removal of the frame after adjusting for the length of distraction in days/cm for both the per protocol (PP) and the intention-to-treat (ITT) groups. The assessor was blinded to the form of treatment. A secondary outcome was to identify covariates affecting the time to removal of the frame.
  
  
  RESULTS
  There was no difference in the time to removal of the frame between the PP (difference in favour of the control group was 10.1 days/cm, 95% confidence interval (CI) -3.2 to 23.4, p = 0.054) or ITT (difference 5.0 days/cm, 95% CI -8.2 to 18.21, p = 0.226) groups. The smoking status was the only covariate which increased the time to removal of the frame (hazard ratio 0.47, 95% CI 0.22 to 0.97, p = 0.042).
  
  
  CONCLUSIONS
  LIPUS does not influence the rate of bone healing in patients who undergo distraction osteogenesis. Smoking may influence bone healing. Cite this article:Bone Joint J2017;99-B:494-502.
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: A H R W
authors.initials: AH
authors.lastname: Simpson
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: G
authors.initials: G
authors.lastname: Keenan
authors.affiliation: Royal Liverpool Children's and Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nayagam
authors.affiliation: Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Atkins
authors.affiliation: University College London, 102 Princetown Road, Bangor, BT20 3TG, UK.
authors.forename: D
authors.initials: D
authors.lastname: Marsh
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
mesh_terms: D000328:Adult; D001861:Bone Regeneration / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D011446:Prospective Studies; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*
keywords: Exogen; Fracture; Healing; Pulsed; Ultrasound