What alternative methods can help promote faster healing of a bone fracture, wound, or surgical incision?

Alternative Methods to Promote Faster Bone Healing

For bone fractures, focus on optimizing nutrition—particularly adequate protein, vitamin D, calcium, and vitamin C—while avoiding unproven interventions like low-intensity pulsed ultrasound (LIPUS), which has strong evidence against its use.

What NOT to Use

Low-Intensity Pulsed Ultrasound (LIPUS)

• LIPUS should not be used for bone healing based on high-quality evidence from randomized controlled trials showing no benefit for functional recovery or accelerated healing in fresh fractures 1
• The 2017 BMJ clinical practice guideline provides a strong recommendation against LIPUS for bone healing in adults with fractures or osteotomies 1
• LIPUS is costly ($1,300-$5,000 per device) and burdensome to use (15-20 minutes daily for weeks to months) without demonstrable benefit on outcomes that matter to patients 1
• Healthcare organizations currently paying for LIPUS should reasonably stop reimbursements based on best current evidence 1

Other Unproven Bone Stimulation Methods

• Electric stimulation and pulsed electromagnetic stimulation lack consensus support for promoting bone healing in congenital pseudarthrosis cases, with only 16% expert agreement 1
• Recombinant human bone morphogenic proteins (rhBMP-2 and rhBMP-7) received only 11% consensus agreement for use in pediatric bone healing 1

Evidence-Based Nutritional Support

Protein Requirements

• Adequate dietary protein is absolutely essential for proper wound and bone healing 2, 3
• Protein deficiency contributes to poor healing rates with reduced collagen formation 4
• High exudate losses can result in protein deficits of up to 100g per day, requiring replacement with high-protein diet 4
• Tissue levels of specific amino acids (arginine and glutamine) may influence wound repair and immune function 2

Vitamins Critical for Bone Healing

Vitamin D and Calcium:

• Vitamin D with phosphate supplements improves pain, osteomalacia, and oral health 1
• Weak evidence suggests these treatments improve healing of post-traumatic or surgical fractures 1
• Insufficient vitamin D intake affects both bone health and healing time after fracture 5

Vitamin C:

• Necessary for collagen formation, proper immune function, and acts as a tissue antioxidant 2
• Vitamin C deficiency contributes to fragile granulation tissue 4
• Essential for wound healing to progress efficiently 4

Vitamin A:

• Required for epithelial and bone formation, cellular differentiation, and immune function 2
• Insufficient vitamin A intake may affect bone health and healing degree 5

Carbohydrates and Fats

• Glucose provides the body's power source for wound healing, supplying energy for angiogenesis and new tissue deposition 4
• Fatty acids are essential for cell structure and play important roles in the inflammatory process 4
• Polyunsaturated fatty acids in the diet are necessary for wound healing 4

Surgical Wound Healing Optimization

For Post-Amputation Wounds

• Removable rigid dressings (RRDs) accelerate healing by 57.8% compared to soft dressings for transtibial amputations 1
• RRDs reduce time to rehabilitation by 46.8% on average 1
• Primary wound healing occurs nearly two weeks earlier with RRDs (51.4 days vs. 64.7 days with soft dressings) 1
• RRDs significantly reduce skin breakdown and distal edema while providing limb protection 1

Adjunctive Biological Materials

• L-PRF (leukocyte and platelet-rich fibrin) membranes can speed up soft tissue healing and facilitate wound closure in case of dehiscence 1
• L-PRF exudate can be applied to surgical sites to promote healing 1
• For bone grafting procedures, bone morphogenic proteins and tricalcium phosphate derivatives can supplement fusion without specific contraindications in non-infected cases 1

Clinical Pitfalls to Avoid

• Do not delay nutritional optimization: Malnutrition and chronic illness significantly impair healing and increase surgical complications 6
• Avoid relying on serum albumin alone: Low serum albumin correlates with pressure ulcer development and poor wound outcomes, but represents only one marker of nutritional status 4
• Do not assume asymptomatic patients don't need treatment: Limited evidence suggests treatment in asymptomatic adults with certain bone conditions improves outcomes 1
• Recognize that wound healing is metabolically demanding: The intricate network of cellular activity causes intensified metabolic demand for nutrients beyond baseline requirements 2

Practical Implementation Algorithm

1. Assess nutritional status immediately upon diagnosis of fracture or before elective surgery 6
2. Ensure adequate protein intake (increase if high exudate losses present) 4
3. Supplement vitamin D, calcium, and vitamin C if dietary intake is insufficient 5
4. For surgical wounds, use appropriate dressings: RRDs for amputations, L-PRF membranes for bone grafting procedures 1
5. Avoid spending resources on LIPUS or electromagnetic stimulation devices 1
6. Continue nutritional support throughout healing period, not just perioperatively 4