Low-intensity pulsed ultrasound and pulsed electromagnetic field in the treatment of tibial fractures: a systematic review.

OBJECTIVE

To compare the effects of low-intensity pulsed ultrasound (LIPUS) or pulsed electromagnetic fields (PEMF) on fracture healing through a systematic review of original, English-language clinical research reports.

DATA SOURCES

A search of MEDLINE, Physiotherapy Evidence Database (PEDro), and ProQuest to identify clinical trials of LIPUS or PEMF with fractures in humans, written in English, published from 1966 through 2004. Key words were ultrasound, fracture, tibial, electric current, and healing.

STUDY SELECTION

After search limits were applied, 17 papers were assessed independently by 2 reviewers. Papers were excluded from consideration if they lacked (1) random allocation of treatments, (2) inclusion of skeletally mature patients of either sex with a current fracture, (3) blinding of both the patient and the assessors as to treatment group, (4) administration of either LIPUS or PEMF treatments to one of the treatment groups, or (5) assessment of time to fracture healing or proportion of fractures healed, as determined radiographically, clinically, or both.

DATA EXTRACTION

Eight trials met the inclusion criteria. Methodologic quality of all trials was assessed using the PEDro criteria. Outcome measures were tabulated.

DATA SYNTHESIS

Heterogeneity among studies precluded direct comparison of the efficacy of LIPUS to that of PEMF.

CONCLUSIONS

The studies we included in our review were of generally high methodologic quality. The evidence suggests that LIPUS may speed healing of acute tibial fractures. Comparison studies of these modalities are needed to guide treatment of fractures sustained by athletic individuals.