{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:56:59Z","timestamp":1781765819548,"version":"3.54.5"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2017,5,1]],"date-time":"2017-05-01T00:00:00Z","timestamp":1493596800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>The clinical value of low-intensity pulsed ultrasound (LIPUS) for fresh fracture is known. Yet, in the absence of a definition of what \u201cfresh\u201d is, payers have adopted study inclusion criteria drawn from randomized clinical trials as de facto definitions of which patients should be treated, with \u201cfresh\u201d defined as &lt;1 week old. Patients with fracture may thus be ineligible for LIPUS treatment after week 1, which potentially denies access to patients who could benefit from LIPUS. We seek to characterize the inflection point at which heal rate declines.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Prospective cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Food and Drug Administration\u2013mandated nationwide postmarketing surveillance registry.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients:<\/jats:title>\n            <jats:p>Observational cohort of 5983 registry enrollees.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>LIPUS, 20 min\/d.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measure:<\/jats:title>\n            <jats:p>Fracture heal rate. Logistic regression was used to model the odds ratio of nonunion from week 1 to week 12. Covariates in the model included age, gender, body mass index, open fracture, and smoking.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>We estimated the time point at which a fracture responds to LIPUS as well as during the first week after fracture. There was significant bone-to-bone variation; metatarsal was \u201cfresh\u201d until week 7, ankle until week 9, humerus until week 10, and femur and radius until week 12. Healing was significantly impacted by patient age, body mass index, and open fracture (all, <jats:italic toggle=\"yes\">P<\/jats:italic> \u2264 0.02).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our results suggest that fractures of the metatarsal, femur, humerus, ankle, and radius respond to LIPUS treatment, as if they were still fresh at least 6 weeks longer than the eligibility allowed under current coverage policies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000000778","type":"journal-article","created":{"date-parts":[[2017,2,15]],"date-time":"2017-02-15T17:12:52Z","timestamp":1487178772000},"page":"248-251","source":"Crossref","is-referenced-by-count":17,"title":["When Is a Fracture Not \u201cFresh\u201d? Aligning Reimbursement With Patient Outcome After Treatment With Low-Intensity Pulsed Ultrasound"],"prefix":"10.1097","volume":"31","author":[{"given":"Robert","family":"Zura","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zekun (Jack)","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Statistics, North Carolina State University, Raleigh, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University, Durham, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Grant","family":"Steen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.2106\/JBJS.RVW.O.00027","article-title":"Enhancement of bone-healing by low-intensity pulsed ultrasound: a systematic review","volume":"4","author":"Rutten","year":"2016","journal-title":"JBJS-Rev."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12891-015-0498-1","article-title":"A cohort study of 4190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients","volume":"16","author":"Zura","year":"2015","journal-title":"BMC Musculoskel Dis."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1016\/j.injury.2015.05.042","article-title":"Treatment of chronic (>1 year) fracture nonunion: heal rate in a cohort of 767 patients treated with low-intensity pulsed ultrasound (LIPUS)","volume":"46","author":"Zura","year":"2015","journal-title":"Injury"},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"A367","DOI":"10.1016\/j.jval.2015.09.731","article-title":"When is a bone fracture no longer \u201cfresh\u201d?","volume":"18","author":"Scott","year":"2015","journal-title":"Value Health"},{"key":"R9-20230828","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1002\/sim.4780141707","article-title":"A multiple imputation strategy for clinical trials with truncation of patient data","volume":"14","author":"Lavori","year":"1995","journal-title":"Stat Med."},{"issue":"(11)","key":"R11-20230828","doi-asserted-by":"crossref","first-page":"e162775","DOI":"10.1001\/jamasurg.2016.2775","article-title":"The epidemiology of fracture nonunion in 18 human bones","volume":"151","author":"Zura","year":"2016","journal-title":"JAMA Surg."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00005131-201705000-00002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T06:16:04Z","timestamp":1693203364000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00005131-201705000-00002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":6,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000000778","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2017,5]]}}}