Low-Intensity Pulsed Ultrasound (LIPUS) for Fracture Healing

I would explain what LIPUS is, its proposed mechanism, the honest state of the evidence, and how it fits alongside standard treatment. LIPUS is a non-invasive, low-risk device that delivers low-intensity pulsed ultrasound to the fracture, applied for about 20 minutes daily by the patient at home, and it is thought to work by mechanotransduction, stimulating bone repair at the molecular level across the stages of healing. Its great attraction is that it is low-risk - the only reported side effect is minor skin reactions - and it avoids the re-hospitalisation, anaesthesia and operative complications of surgery. However, I would be honest about the evidence: high-quality randomised trials have shown inconsistent or limited benefit for fresh fracture healing, so it is not established as routinely accelerating ordinary fractures; the stronger rationale is in delayed union and non-union, which is the situation here, and non-inferiority trials comparing LIPUS with surgery for non-union are ongoing. I would emphasise that surgical revision remains the gold standard for an established non-union, and, most importantly, that non-union is multifactorial - so before or alongside any device I would ensure the fracture has adequate mechanical stability and alignment, exclude and treat infection, and address host and biological factors such as smoking, diabetes and vascularity. So I would frame LIPUS as a reasonable low-risk adjunct, or in selected cases an alternative to surgery, while being clear that it is not a substitute for treating the underlying cause of the non-union and that the evidence is mixed.