501 patients with a closed or open tibial shaft fracture were randomized to postoperative use of either therapeutic low-intensity pulsed ultrasound (LIPUS) or sham, daily, until fracture union. The purpose of this study was to compare functional recovery and the time to union between groups within a 52-week follow-up. Results demonstrated that postoperative use of LIPUS after tibial fracture fixation does not accelerate radiological healing. No significant differences between groups were noted in any outcome measure over the duration of follow-up, including subgroup analysis of treatment efficacy in closed fractures and open fractures, separately.