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Ultrasound treatment after tibial fracture surgery offers no benefit, study finds

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Low intensity ultrasound is sometimes used after surgery to repair a fractured tibia (shinbone), with the aim of improving recovery. But a large international study published by The BMJ shows that it doesn´t work.

The randomised controlled trial was led by researchers at McMaster University in Ontario, Canada. It involved 501 US adults who underwent surgery for a tibial fracture at 43 North American academic trauma centres between October 2008 and September 2012.

The researchers wanted to find out whether low intensity pulsed ultrasonography (LIPUS), compared with sham treatment, accelerates healing or improves functional recovery after surgery for tibial fracture.

Fractures of this kind are slow to heal and often need further surgery to heal completely. Because of this, tibial fractures have been a prime target for numerous interventions to aid recovery.

LIPUS was approved for fracture healing by the US Food and Drug Administration (FDA) in 1994.

In the trial, the patients were assigned 20-minute daily treatment with either LIPUS or a placebo device which looked the same. Patients were followed until X-rays showed their fracture was healed, or for 12 months.

The main outcome was time to fracture healing over one year, assessed with radiographs. Other outcomes included functional and quality of life measures reported by patients, such as return to work and leisure activities, and time to full weight bearing.

Results showed no significant differences between the two groups for any outcome.

“Addition of LIPUS to usual care for patients with fracture failed to accelerate radiographic healing or improve function,” the researchers concluded.

An accompanying editorial suggests “it is time to abandon this ineffective treatment” now that there is strong evidence it does not work.

http://www.bmj.com/company/wp-content/uploads/2016/10/the-bmj-fracture.pdf

http://dailynews.mcmaster.ca/article/popular-ultrasound-treatment-doesnt-improve-fracture-healing/

http://www.bmj.com/content/355/bmj.i5351