Clinical advances in the treatment of fracture nonunion: the response to mechanical stimulation

Nonunions, which occur in over 100,000 patients in the United States per year, are significant consequences in treating fractures. Ultrasound is a form of mechanical energy transmitted to bone as high frequency acoustic pressure waves. Previous trials have suggested that ultrasound significantly reduces the healing time of conservatively managed tibial shaft and distal radial fractures. Recent evidence suggests that ultrasound's utility may also be generalized to scaphoid fractures. However, a recent randomized trial suggests that ultrasound offers no additional benefit in those patients with tibial shaft fractures treated with reamed intramedullary nailing. Here, we present an overview of the recent clinical advances with ultrasound therapy and pulsed electromagnetic field therapy in augmenting fracture healing. We also conduct a meta-analysis of randomized trials to include this recent evidence.