The evidence for low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures raises no major safety concerns. The current evidence on efficacy is inadequate in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to do low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public on low-intensity pulsed ultrasound is recommended.
Audit and review clinical outcomes of all patients having low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. NICE has identified relevant audit criteria and has developed NICE's interventional procedure outcomes audit tool.
The procedure should be used with other treatments for delayed-union and non-union fractures. It should be managed by specialists in treating these fractures.
NICE encourages further research into low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. Further research should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.