CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND)

Andrew Harrison

doi:10.1302/1358-992X.2021.2.094

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CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND)

The British Orthopaedic Research Society (BORS) Annual Meeting 2020, held online, 7–8 September 2020.

Andrew Harrison

CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND)

Harrison A. CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND). Orthop Procs. 2021;103-B(SUPP_2):94-94. doi:10.1302/1358-992X.2021.2.094

Harrison, Andrew. “CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND).” Orthopaedic Proceedings, vol. 103-B, no. SUPP_2, 2021, pp. 94-94., https://doi.org/10.1302/1358-992X.2021.2.094

Harrison, A. (2021). CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND). Orthopaedic Proceedings, 103-B(SUPP_2), 94-94. https://doi.org/10.1302/1358-992X.2021.2.094

Harrison, A. (2021) “CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND).” Orthopaedic Proceedings, 103-B(SUPP_2), pp. 94-94. Available at: https://doi.org/10.1302/1358-992X.2021.2.094

Harrison, Andrew. “CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND).” Orthopaedic Proceedings 103-B, no. SUPP_2 (2021): 94-94. https://doi.org/10.1302/1358-992X.2021.2.094

Harrison A. CLINICAL FRACTURE TREATMENT WITH LIPUS (LOW-INTENSITY PULSED ULTRASOUND). Orthop Procs. 2021 Mar 1;103-B(SUPP_2):94-94. https://doi.org/10.1302/1358-992X.2021.2.094

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Abstract

Objectives

Review the evidence of low intensity pulsed ultrasound (LIPUS) for fracture non-union treatment and the potential to treat fractures in patients with co-morbidities at risk of fracture non-union.

Methods

Data was gathered from both animal and human studies of fracture repair to provide an overview of the LIPUS in bone healing applications to provide in-depth evidence to substantiate the use in treatment of non-union fractures and to propose a scientific rational to develop a clinical development programme.

Results

LIPUS is an effective method for treating fracture non-union, with most studies showing heal rates in the mid 80%. In the UK NICE has published MTG-12 guidance for non-union treatment, which demonstrates that LIPUS is an effective and cost effective method as an alternative to surgery to treat non-union fractures.

Basic science studies and evaluation of clinical trial data has led to the understanding that LIPUS can mitigate co-morbidities related to failure of bone healing such as diabetes, advancing age and tobacco use. Future clinical trials will evaluate the use of LIPUS in acute fractures in patients with high risk of low bone healing capacity to prevent the development of a non-union

As with all medical treatments, LIPUS for fracture repair needs to be used appropriately, with poorly fixed fractures or large fracture gaps, being unsuitable for LIPUS treatment. In addition, considerations such as targeting the fracture site in deep-seated bones and clinician / patient engagement to ensure good compliant usage are vital factors to ensure good clinical outcomes.

Conclusion

Using basic science research, a thorough knowledge of the mechanism of action has been established, which has elucidated that co-morbidities related to the development of fracture non-union can be mitigated by the LIPUS technology. A pragmatic clinical trial in the United States is currently ongoing to test these hypothesises clinically.