What is the role of ultrasound in fracture management?

Abstract

Objectives The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management. Methods A review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”. Results The use of ultrasound in musculoskeletal medicine has expanded rapidly over the last two decades, but the diagnostic use in fracture management is not routinely practised. Early studies have shown the potential of ultrasound as a valid alternative to radiographs to diagnose common paediatric fractures, to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. Ultrasound has also been shown to be advantageous in the early identification of impaired fracture healing; with the advent of 3D image processing, there is potential for wider adoption. Detection of implant-related infection can be improved by ultrasound mediated sonication of microbiology samples. The use of therapeutic ultrasound to promote union in the management of acute fractures is currently a controversial topic. However, there is strong in vitro evidence that ultrasound can stimulate a biological effect with potential clinical benefit in established nonunions, which supports the need for further investigation. Conclusion Modern ultrasound image processing has the potential to replace traditional imaging modalities in several areas of trauma practice, particularly in the early prediction of impaired fracture healing. Further understanding of the therapeutic application of ultrasound is required to understand and identify the use in promoting fracture healing. Cite this article: J. A. Nicholson, S. T. J. Tsang, T. J. MacGillivray, F. Perks, A. H. R. W. Simpson. What is the role of ultrasound in fracture management? Diagnosis and therapeutic potential for fractures, delayed unions, and fracture-related infection. Bone Joint Res 2019;8:304–312. DOI: 10.1302/2046-3758.87.BJR-2018-0215.R2.

Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series

“…Fracture nonunion and delayed unions continue to be a challenge in clinical practice with nonunions having a considerable impact on patient’s quality of life causing functional and psychosocial disability along with it being the cause of an economic burden owing to prolonged disability and downtime of job [ 5 ]. Although ultrasound is routinely indicated as a diagnostic modality in Trauma & Orthopaedics, its use as a therapeutic intervention is still not well understood [ 6 ].…”

Diagnostic Accuracy of 3D Ultrasound and Artificial Intelligence for Detection of Pediatric Wrist Injuries

“…We expect that ED physicians with point-of-care US training can readily employ this technique to evaluate patients and make decisions on additional imaging. Furthermore, while US images are considered highly user-dependent [ 9 , 17 ], by capturing a sweep of the fracture and allowing for retrospective review, user dependency can be reduced and allow any healthcare practitioner to obtain a useful scan, and ED physicians can review the scan at their convenience. This also allows radiologists to aid in the interpretation of the study if there are any concerns.…”

“…Another key benefit of 3DUS was that the ‘sweep’ images obtained gave a comprehensive dataset, showing the full anatomy of the distal radius and ulna, suitable for automated reconstruction using artificial intelligence (AI), and eventually, automated diagnosis of wrist fractures [ 17 ].…”

Antibiofilm efficacy of focused high-energy extracorporeal shockwaves and antibiotics in vitro

“…Focused high-energy extracorporeal shockwave therapy (fhESWT) is a non-invasive alternative for the treatment of fracture or arthrodesis nonunions with healing rates of nonunions up to 70% to 90% after six months. 10 - 12 This therapy uses longitudinal acoustic waves to emit energy at areas with impedance discontinuities, such as the soft tissue to implant interface. The mechanism is not yet fully understood, however osteo- and angioinductive effects appear to play an important role.…”