[Physical treatment options with impact on bone healing]

Area of Science:

• Orthopedics and Regenerative Medicine
• Biomedical Engineering
• Clinical Research

Background:

• Fracture healing is complex, influenced by numerous patient and injury factors, complicating the evaluation of physical stimulation.
• Current evidence on physical modalities for fracture healing, particularly nonunions, is limited by study quality and bias.
• Extracorporeal Shock Wave Therapy (ESWT) is technically challenging and carries risks, yet is used for nonunions.

Purpose of the Study:

• To assess the effectiveness of physical stimulation methods, specifically ESWT and LIPUS, in promoting fracture healing.
• To evaluate the evidence base for ESWT and LIPUS in treating acute fractures, delayed unions, and nonunions.
• To compare the efficacy and evidence quality of ESWT and LIPUS for bone consolidation.

Main Methods:

• Systematic reviews and meta-analyses were used to evaluate existing studies on ESWT and LIPUS.
• Randomized controlled trials (RCTs) were assessed for bias and effectiveness in fracture healing.
• Analysis focused on outcomes for acute fractures, delayed unions, and nonunions, including fusion rates and healing times.

Main Results:

• ESWT shows potential for nonunions with positive bony healing in 70-71% of patients, comparable to surgery (73%), but study quality is inconsistent.
• Low-Intensity Pulsed Ultrasound (LIPUS) has a better evidence base, with RCTs showing reduced healing time for acute fractures and improved consolidation for tibial nonunions (80% fusion rate).
• LIPUS effectiveness for nonunions is higher in biologically active lesions and in patients without recent prior surgical intervention.

Conclusions:

• While ESWT may aid nonunion treatment, its evidence base is limited and carries risks.
• LIPUS demonstrates significant promise for enhancing fracture consolidation, particularly in delayed unions and nonunions, with higher quality evidence.
• Further high-quality research is needed to fully elucidate the role and optimal application of physical stimulation in fracture management.