Heal rate of metatarsal fractures: A propensity-matching study of patients treated with low-intensity pulsed ultrasound (LIPUS) vs. surgical and other treatments

Peter Nolte, Robert Anderson, Elton Strauss, Zhe Wang, Liuyi Hu, Zekun Xu, R. Grant Steen

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Introduction Whether to treat metatarsal fractures conservatively or surgically is controversial. We test a hypothesis that metatarsal fractures treated conservatively with non-invasive low-intensity pulsed ultrasound (LIPUS) obtain heal rates comparable to current surgical techniques. Patients and methods This is a retrospective observational cohort study, using patient outcomes from a prospectively-collected LIPUS registry required by the U.S. Food & Drug Administration. Registry data were collected over a 5-year period and were reviewed and validated by a registered nurse. Data required for analysis were days-to-treatment (DTT) with LIPUS and a dichotomous outcome of healed versus failed, as assessed by clinical and radiographic criteria. Registry patients (DTT < 365 days) were propensity-matched to metatarsal fracture patients from a health claims database that includes medical and drug expenses for ∼90.1 million patients. The propensity match was based on patient demographic data (age, gender, body weight, fracture severity, and smoking status). Results A total of 594 metatarsal fractures were treated with LIPUS, including 161 Jones fractures. Compared to patients in the claims database, LIPUS-treated patients were more likely to: be overweight or obese; be male; have open fracture; and smoke (all, P < 0.0001), suggesting that these variables were perceived as nonunion risk factors by prescribing physicians. After propensity-matching, none of these differences between the registry and the health claims database remained significant. The heal rate with LIPUS treatment was 97.3%, comparable to the heal rate of 95.3% among claims patients in 2011 who did not receive LIPUS (P = 0.0654). When fresh fractures (0–90 days) and delayed unions (91–365 days) were analyzed separately, the LIPUS fresh fracture heal rate was superior to claims patients (P = 0.0381), and the delayed union heal rate was comparable. After exclusion of registry patients who received surgery, heal rate with LIPUS alone (97.4%) was significantly better (P < 0.0097) than the heal rate for matched patients in 2011 (94.2%). Conclusions LIPUS significantly improved the heal rate of metatarsal fractures <1 year old without surgery (P = 0.0097). Metatarsal fractures treated with LIPUS alone have a heal rate comparable to fractures treated by surgical intervention.

Original languageEnglish
Pages (from-to)2584-2590
Number of pages7
Issue number11
StatePublished - 1 Nov 2016


  • Jones fracture
  • Obesity
  • Open fracture
  • Tobacco smoking


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