Low-intensity pulsed ultrasound for non-union treatment: A 14-case series evaluation

SummaryIntroductionNon-union is presently managed exclusively by surgery, but alternative treatments are under evaluation.ObjectiveTo assess the benefit of external ultrasound stimulation in surgically treated lowerlimb long-bone non-union.Patients and methodsA 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 20 min stimulation daily over a period of 3 months. Regular clinical and radiological follow-up checked treatment efficacy.ResultsThe 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.DiscussionThe 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 evidenceRetrospective study, level IV.