Use of Low-Intensity Pulsed Ultrasound for Posttraumatic Nonunions of the Tibia: A Review of Patients Treated in The Netherlands

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Low-intensity pulsed ultrasound is effective in fresh fracture healing, resulting in a 40% reduction in healing time. The aim of this study is to determine the effect of ultrasound treatment on established tibia nonunions.


The study group consists of all Dutch patients of posttraumatic consecutive nonunion of the tibia, who started their ultrasound treatment between January 2000 and February 2003. In total, 71 cases have been included, which involve 56 men and 15 women. Mean age was 40 years. Low-intensity pulsed ultrasound was the only new treatment. Strict criteria of enrollment minimized any spontaneous healing chance. According to literature, the spontaneous healing rate was between 5% and 30%. The study outcome, healed or failed, was the primary efficacy parameter. Thirty percent was chosen to represent the maximum expected spontaneous healing and was the basis for statistical evaluation. Stratification was performed for the variables at the ultrasound treatment start.


The overall healing rate is 52 of 71 cases (73%). Ultrasound treatment shows a statistical significant higher healing rate compared with that of the spontaneous healing chance (p < 0.0001). Stratification shows no statistical significance for any of the variables analyzed. The long-term follow-up shows high compliance rate and no refractures.


Tibia nonunions have a high occurrence rate and cause significant impairment to daily functioning. This study shows that low-intensity pulsed ultrasound is effective in the treatment of established tibia nonunions and can be seen as a good, safe, and cheaper alternative to surgery.

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