LIPUS: An Effective Alternate Option to Treat Nonunions of Fractures and Surgical Fusions in Trauma and Orthopaedic Surgery

Background: Limited studies have been conducted to evaluate the use of exogen in different patient groups. We aim to determine the rate of radiological union and symptom resolution following use of Low Intensity Pulsed Ultrasound (LIPUS) therapy, to analyse the efficacy of LIPUS therapy in comparable patient groups, and to determine the cost effectiveness of LIPUS therapy.

Materials and Methods: 32 adult patients with nonunions of fractures and surgical fusions who were treated with LIPUS over 3 years were identified from the clinic database. Data were recorded retrospectively. Patients were divided into 3 subcategories to provide a meaningful analysis of comparable groups: foot and ankle versus other regions, surgical versus conservative management, and atrophic versus hypertrophic nonunion. A statistical calculator was employed for statistical analysis.

Results: Clinical symptoms of nonunion resolved in 19 (59%) patients and radiological union was achieved in 18 (56%) patients post LIPUS use. The foot and ankle group demonstrated the best outcome, with union rates of 73% when compared to other fractures at 44% union. Significant potential cost savings of £3150 per patient have been calculated (p=0.006) when compared to surgical management of nonunion.

Discussion: Overall, we achieved just under 60% resolution of clinical symptoms and/or radiological improvement, without the need for further intervention. In our study we observed particularly better outcomes in the foot and ankle group compared to other fractures; this could provide guidance for future targeting of LIPUS therapy to specific patient cohorts based on their anatomical regions of nonunion.

Keywords: LIPUS; Exogen; Fracture; Nonunion.