TY - JOUR
T1 - Heal rate of metatarsal fractures
T2 - A propensity-matching study of patients treated with low-intensity pulsed ultrasound (LIPUS) vs. surgical and other treatments
AU - Nolte, Peter
AU - Anderson, Robert
AU - Strauss, Elton
AU - Wang, Zhe
AU - Hu, Liuyi
AU - Xu, Zekun
AU - Grant Steen, R.
N1 - Publisher Copyright:
© 2016 Bioventus LLC
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - Jones fracture
KW - Obesity
KW - Open fracture
KW - Tobacco smoking
UR - http://www.scopus.com/inward/record.url?scp=84994128083&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2016.09.023
DO - 10.1016/j.injury.2016.09.023
M3 - Article
C2 - 27641221
AN - SCOPUS:84994128083
SN - 0020-1383
VL - 47
SP - 2584
EP - 2590
JO - Injury
JF - Injury
IS - 11
ER -