gms | German Medical Science

Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

Use of low-intensity pulsed ultrasound for post-traumatic nonunions of the tibia, a review of patients treated in the Netherlands

Meeting Abstract

  • S. Rutten - Department of Orthopaedics and Traumatology, Hospital Hilversum, Hilversum, Netherlands
  • P.A. Nolte - Department of Orthopedics, Spaarne Hospital, Hoofddorp, Netherlands
  • G.L. Guit - Department of Radiology, Kennemer Gasthuis, Haarlem, Netherlands
  • D.E. Bouman - Department of Orthopaedics and Traumatology, Hospital Hilversum, Hilversum, Netherlands
  • G.H.R. Albers - Department of Orthopaedics and Traumatology, Hospital Hilversum, Hilversum, Netherlands

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.8.3-259

The electronic version of this article is the complete one and can be found online at:

Published: September 28, 2006

© 2006 Rutten et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Aim: 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.

Methods: The study group consists of all Dutch post-traumatic consecutive nonunion cases of the tibia, which started ultrasound treatment between January 2000 and February 2003. In total 71 cases have been included; 56 males and 15 females. Mean age was 40 years and mean fracture age was 257 days. Low-intensity pulsed ultrasound was the only new treatment. The study outcome, healed or failed, was the primary efficacy parameter. Strict criteria of enrolment minimize any chance on spontaneous healing. According to the literature the spontaneous healing rate is between 5 to 30%. Therefore 30% percent was chosen to represent the maximum expected chance on spontaneous healing and was the basis for statistical evaluation. Secondary review has been performed by an independent radiologist. A questionnaire was sent to all included patients to assess treatment commitment, medication use, co-morbidity and long term follow-up status. Stratification has been performed for all variables present at the start of ultrasound treatment; location of fracture in tibia, comminution, open/closed, nonunion type, fracture age, fixation before and during ultrasound, prior surgical procedure interval, patient age, sex, body mass index and smoking habit.

Results: The overall healing rate was 52 of 71 cases (73%). Mean healing time was 184 days. Ultrasound treatment shows a statistical significant higher healing rate compared to the largest spontaneous healing chance according to the literature (p<0.0001). Stratification shows no statistical significance for any of the variables analyzed. Although not significant: smokers show a lower healing rate (63 %) than non smokers (84%). Nonunions located in the middle third of the tibia showed a healing rate of only 53% compared to 89% and 77% for the distal and proximal located nonunion. There was no discrepancy in healing rate after secondary review by an independent radiologist. The long term follow-up shows a high compliance rate and no re-fractures.

Conclusion: 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.