This systematic review examines the efficacy and safety of whole body vibration (WBV) on fracture healing. A systematic literature search was conducted with relevant keywords in PubMed and Embase, independently, by two reviewers. Original animal and clinical studies about WBV effects on fracture healing with available full-text and written in English were included. Information was extracted from the included studies for review. In total, 19 articles about pre-clinical studies were selected. Various vibration regimes are reported; of those, the frequencies of 35 Hz and 50 Hz show better results than others. Most of the studies show positive effects on fracture healing after vibration treatment and the responses to vibration are better in ovariectomised (OVX) animals than non-OVX ones. However, several studies provide insufficient evidence to support an improvement of fracture healing after vibration and one study even reports disruption of fracture healing after vibration. In three studies, vibration results in positive effects on angiogenesis at the fracture site and surrounding muscles during fracture healing. No serious complications or side effects of vibration are found in these studies. WBV is suggested to be beneficial in improving fracture healing in animals without safety problem reported. In order to apply vibration on fractured patients, more well-designed randomised controlled clinical trials are needed to examine its efficacy, regimes and safety.
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THE EFFECT OF WHOLE BODY VIBRATION ON FRACTURE HEALING -A SYSTEMATIC REVIEW IntroductionFracture is a common musculoskeletal problem with high morbidity. Most fractures usually heal uneventfully well, but about 5-10 % of the fractures result in impaired healing, such as delayed union and non-union (Rozen et al., 2007). Therefore, it is of great importance to develop more efficient management to minimise delayed union and nonunion. Fracture healing is a complicated biological process that consists of an inflammatory stage, repair stage and remodelling stage (Kalfas, 2001). The healing process can be influenced by various factors, of which biomechanical condition at the fracture site is considered as one of the key determinants (Einhorn, 1998;Hannouche et al., 2001 et al., 2014). Some studies provide evidence that WBV has effects on the musculoskeletal system, including improving muscle function (Rees et al., 2008;Sitja-Rabert et al., 2015), increasing bone mineral density (BMD) (Lam et al., 2013;Verschueren et al., 2004), reducing risks of falls and improving muscle strength and balancing ability . Low-magnitude high-frequency vibration (LMHFV), a type of WBV with magnitude usually lower than 1 ×g [magnitude, in gravitational acceleration (m/s2 )] and frequency ranged from 20 to 90 Hz (Bemben et al., 2010;Fuermaier et al., 2014;von Stengel et al., 2011), is also reported to have positive effects on osteogenic differentiation and osteogenesis (Dumas et al., 2010;Kim et al., 2012;Leung et al., 2014;Luu et al., 2009). Some previous studies usi...
