The acronyms are getting bigger. LIPUS (Low Intensity Pulsed Ultrasound) therapy is commonly used to heal fractures faster, or to get them to heal when they have not. It is a machine that straps on to the limb and is worn for minutes or hours each day, for a few weeks or months. Just like the techniques in my recent posts, it costs several thousand dollars and people assume that if it costs that much and is high-tech, it must be working. Lets cut to the chase.
Again, I am concentrating on the scientific evidence. Like many other treatments, there is abundant scientific evidence that it does amazing things to cell in a dish, and even mice and sheep, but the list of treatments that work well in lab animals and cells but have no effect in humans is too long to mention. To help me find the real (human) evidence, one of the companies has helpfully listed the evidence for me under a tab named “Here’s the proof” on their patient-targeting website, enticingly named “healmybone.com”.
There are two claims: that it heals bones that have not healed after a long time (non-union) and that it makes fresh fractures heal faster. Scientific clinical studies (randomised trials in humans) are limited, but they are there.
For the treatment of fresh (acute) fractures, it makes the bone heal faster on X-ray. We now that new bone formation around fractures is stimulated by movement. The ultrasound shakes up the bone, and consequently more bone is made around the fracture, so it kind of makes sense. However, in the landmark papers from the 90’s on tibia (leg) and radius (wrist) fractures, all of the fractures healed anyway. These two papers are similar. So similar that they have cut and pasted whole sections from one to the other, and the authors in both studies received benefits from the sale of the device, and several authors were employees of the company that made the device. And several of the authors appeared on both studies. Even the authors that wrote the review on this topic had conflicts of interest.
I don’t mind if the employees wrote the study, particularly as the two landmark studies were good studies, using concealed placebo devices, which is the best way to test these things. As long as there is verification from and independent study (where the authors are not receiving benefits form the manufacturer), everything is fine. However, a similar study from non-conflicted authors in Sweden found no statistically significant difference between the treatment groups (the placebo groups actually healed a little quicker).
Interestingly, there are no studies comparing LIPUS to placebo for the treatment of non-union (which surprised me, as I actually thought there was good evidence out there for the use of LIPUS in non-unions).
In short, this expensive treatment is only supported by studies that were sponsored by the manufacturer and written by employees and doctors who benefit from the sale of the device. Even in these studies, all of the fractures healed anyway. And there is no good evidence for using it in fractures that have not healed. My advice? Strap on a placebo, independent research shows that it might work a little better.