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  • Title: Low-intensity pulsed ultrasound for non-union treatment: a 14-case series evaluation.
    Author: Hemery X, Ohl X, Saddiki R, Barresi L, Dehoux E.
    Journal: Orthop Traumatol Surg Res; 2011 Feb; 97(1):51-7. PubMed ID: 21269906.
    Abstract:
    INTRODUCTION: 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. PATIENTS AND 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. DISCUSSION: 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. LEVEL OF EVIDENCE: Retrospective study, level IV.
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