The impact of low intensity, pulsed ultrasound on fracture healing is controversial. This review summarizes the authors' research on therapeutic ultrasound in fracture management. Our survey of orthopaedic surgeons and senior physiotherapy students found that use of therapeutic ultrasound is rare, due primarily to a perceived lack of evidence and lack of availability. There is evidence from randomized trials that low intensity ultrasound may significantly reduce the time to fracture healing, particularity in those fractures treated non-operatively. The benefit of ultrasound following operatively-managed fractures remains uncertain. Our economic analysis suggests that, from both governmental and societal perspectives, reamed intramedullary nailing is the treatment of choice for closed and open grade I tibial shaft fractures: however, there is evidence from a societal perspective that treatment of low energy tibial fractures with therapeutic ultrasound and casting may also be an economically-sound intervention. Larger trials are needed to resolve the role of therapeutic ultrasound in fracture healing.