II-3 Low-Intensity Pulsed Ultrasound (LIPUS) Therapy for Hip Fracture.

Agreement of the cooperating hospital is required for a decision relating to the liaison critical pathway, which ensures cooperation among regional hospitals. This can make deployment of non-standard hip fracture treatment difficult. We report the process by which we adopted LIPUS treatment into the liaison critical pathway. The medical remuneration for LIPUS therapy is 50,000 Japanese Yen and can be credited only when treatment starts. Therefore, continuation of the treatment requires agreement of the cooperating hospital. Evidence about the effectiveness of the LIPUS therapy is necessary to get such agreement, yet no evidence was available for femoral trochanteric fractures. We performed a prospective clinical study in the Kumamoto Seamless Care Network of Hip Fracture. Four hospitals participated in the study. We randomly allocated consenting patients to LIPUS treatment or no LIPUS control. For LIPUS, the treatment focus was determined using X-ray, and treatment was 20 minutes per day, continuing after the patient changed hospitals. Full weight-bearing was allowed 1 day after operation. Bone union was defined as both anterior cortices completely bridged in an anteroposterior and lateral X-ray image. Bone union was determined by an orthopedist not involved in treatment. Bone union was achieved significantly earlier, by approximately 2 weeks, in the LIPUS group. LIPUS therapy was therefore included in the liaison critical pathway.
PMID: 24854466