Abstract
BackgroundThe standard treatment to enhance fracture healing of scaphoid nonunions is surgery. Low-intensity pulsed ultrasound (LIPUS) is gaining in popularity as an alternative treatment to improve fracture healing; however, little is known about success rates of this treatment in scaphoid-delayed unions. The purpose of our study is to define the success rate of LIPUS treatment for delayed union of scaphoid fractures and further analyze whether initial management or fracture type influences success rate.MethodsDuring the period of 2011–2013, in the central orthopedic clinic of our institution, patients diagnosed with delayed union of the scaphoid were offered with LIPUS treatment as an alternative to conventional surgical treatment. These patients were then divided into subgroups according to the time elapsed from initial injury until diagnosis of the fracture.ResultsOverall, 22 of 29 (76 %) fractures healed, 12 of 13 (92 %) of the early diagnosed group, and 10 of 16 (63 %) of the late diagnosed group. Difference in healing rate between proximal pole, waist, and distal pole fractures was not statistically significant.ConclusionLIPUS can help heal delayed union scaphoid fractures, especially in fractures diagnosed and treated soon after injury and may serve as an alternative to surgical treatment.
Highlights
The standard treatment to enhance fracture healing of scaphoid nonunions is surgery
During the period of 2011–2013, patients in the central orthopedic clinic of our institution were offered with Low-intensity pulsed ultrasound (LIPUS) treatment as an alternative to conventional surgical treatment when delayed union of the scaphoid was diagnosed
Delayed union was defined if 3 months to 1 year elapsed from the initial injury with no signs of fracture healing or if the fracture was only tenuously united
Summary
The standard treatment to enhance fracture healing of scaphoid nonunions is surgery. Low-intensity pulsed ultrasound (LIPUS) is gaining in popularity as an alternative treatment to improve fracture healing; little is known about success rates of this treatment in scaphoid-delayed unions. The importance of a correct diagnosis and appropriate treatment of these fractures lie in the scaphoid’s tenuous blood supply, which may explain the increased frequency of delayed union, nonunion, and avascular necrosis (AVN) of scaphoid fractures. Most hand surgeons recommend open reduction and internal fixation of the nonunion combined with a bone graft [5, 6]. This treatment results in a union rate as high as 97 % [7]
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