Send to

Choose Destination
J Foot Ankle Surg. 2019 Nov;58(6):1145-1151. doi: 10.1053/j.jfas.2019.03.010. Epub 2019 Sep 20.

Delayed Healing in Metatarsal Fractures: Role of Low-Intensity Pulsed Ultrasound Treatment.

Author information

Orthopaedic Surgeon, OrthoCarolina, Charlotte, NC.
Professor of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University, Durham, NC.
President, Braid-Forbes Health Research, Silver Spring, MD.
Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Louisiana State University Health Science Center, New Orleans, LA. Electronic address:


The most common fracture in primary care is metatarsal fracture, but it is controversial whether to treat this fracture conservatively or surgically. We performed a cohort study to contrast metatarsal fractures that heal normally with fractures that show delayed healing. We analyzed 5% Medicare Standard Analytic Files, selecting all metatarsal fractures in 2011 to 2013, excluding patients with multiple fractures. Delayed healing was defined as treatment >14 days postfracture with either low-intensity pulsed ultrasound or surgery. Treatment for delayed healing was identified using the Current Procedural Terminology and International Classification of Diseases, Revision 9, Clinical Modification codes. Among 9482 metatarsal fractures, 256 (2.7%) showed delayed healing. Patients with delayed healing were younger (p < .0001); more likely to receive specialist referral (p < .001); more likely to have obesity (p = .005), psychosis (p = .003), chronic lung disease (p = .012), or iron deficiency anemia (p = .016); and more likely to receive surgery before ultrasound (p < .0001). Patients more likely to be treated with surgery than ultrasound included younger patients (p < .0001), obese patients (p = .02), and patients who first see a specialist (p < .05).


Medicare; anemia; nonunion; obesity; reimbursement policy


Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center