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Abstract
The goal of this review is to present the most updated knowledge derived from basic
science, animal studies and clinical trials, concerning biophysical stimulation of
bone repair through low-intensity pulsed ultrasound (LIPUS), with particular reference
to the management of delayed unions and nonunions. Low-intensity pulsed ultrasound
LIPUS has been proved to significantly stimulate and accelerate fresh fracture healing
in animal studies and in randomized controlled clinical trials. LIPUS also appears
as an effective and safe home treatment of aseptic and septic delayed-unions and nonunions,
with a healing rate ranging from 70% to 93% in different, nonrandomized, studies.
Advantages of the use of this technology that may avoid the need for additional complex
operations for the treatment of nonunions, include efficacy, safety, ease of use and
favourable cost/benefit ratio. Outcomes depend on the site of nonunion, time elapsed
from trauma, stability at the site of nonunion and host type. The detailed biophysical
process by which low-intensity pulsed ultrasound LIPUS stimulates bone regeneration
still remains unknown, even if various effects on bone cells in vitro and in vivo
have been described.