Observational, Non-interventional Use of LIPUS to Mitigate Fracture Non-union in Patients at Risk

The prospective arm of this non-interventional, observational study is designed to collect
real world evidence from patients at risk of a fracture non-union across the US receiving
EXOGEN treatment. Patients will be followed for 9 months post fracture. As a
non-interventional study, the treating clinician will continue to provide routine care
without research intervention or dictation by a protocol. A medically staffed
Direct-to-Patient Contact Center will serve as a central investigational site with scheduled
and structured direct-to-patient contacts via phone/email/text/web based surveys to obtain
informed consent and collect data directly from the patient. For all prospective patients,
primary effectiveness data will be obtained directly from the medical records of the treating
physician.

The comparator arm of this study will be a retrospective cohort of patients within a national
health insurance claims database. An extract of this database will be taken and eligible
controls derived via propensity score analysis.

Inclusion Criteria:

1. Must be willing to provide voluntary informed consent

2. Male or female age 21-80 on fracture date

3. Must be willing to sign for release of medical insurance claim billing records from
the treating clinician, pertaining to the fracture and fracture treatment

4. Fluency in English and/or Spanish

5. Prescriptive initiation of therapy with the EXOGEN Ultrasound Bone Healing System
(Model number 71034400) for a specified fracture

6. Bone specific fracture

Exclusion Criteria:

1. Patient report of treatment with an electrical bone growth stimulation device (e.g.,
pulsed electromagnetic field (PEMF) or capacitive coupling (CC) based devices) for
bone fracture in 9-months pre-index period up to baseline phone contact

2. Pregnant on fracture index date

3. Evidence that prescription for EXOGEN has been written to treat a fracture non-union
or mal-union (i.e, ICD-10-CM code with seventh character modifier of K, P or S).

4. Evidence that prescription for EXOGEN has been written to treat a pathologic fracture
(ICD-10-CM code M80. or M84.) or neuropathic bone (ICD-10-CM code M14.6)

5. Patient with a concurrent fracture of the other bones of interest

6. Patients who are or anticipate living or receiving fracture treatment outside of the
US during the post-index fracture period

7. Patient report of history of primary or metastatic bone cancer

8. Patient report of bone infection or osteomyelitis of index fracture at baseline
contact

9. Patient report of prior bone specific fracture in 9-months pre-index period

10. Patient prescribed EXOGEN as part of a Worker Compensation claim