Effect of low-intensity pulsed ultrasound treatment for delayed and non-union stress fractures of the anterior mid-tibia in five athletes.

Effects of optional use of low-intensity pulsed ultrasound (LIPUS) treatments for delayed and non-union stress fractures at the anterior mid-tibia in athletes were examined. The subjects were 5 competitive athletes (4 males and 1 female) with the anterior mid-tibia stress fracture, which was confirmed by radiography and bone scintigraphy (Technetium-99m). All patients consistently received daily 20-minute LIPUS treatment, until radiographic recovery was achieved. Recovery was evaluated using clinical symptoms, radiographic examination, bone scintigraphy and functional outcome. Patients returned to full sports activity at an average of 3 months after the onset of treatment (range, 2 to 4 months). Absence of pain was achieved at an average of 3.8 months (range, 2 to 5 months), and disappearance of bone umbauzone was achieved at an average of 11 months (range, 8 to 14 months). These results were clearly faster than that of other previously reported conservative treatments. Thus, the LIPUS treatment is useful for early alleviation of focal pain in anterior mid-tibia stress fracture (delayed and nonunion stress fracture), resulting in early return to sports activity. However, achievement of pain-free status did not coincide with radiological indications of bone healing, thus careful follow-up should be necessary.