Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

Abstract

).Attempts by clinicians to maximize the healing potential of nonunions have led to the use of adjunctive treatment modalities such as low-intensity pulsed ultrasound therapy. The safety and efficacy of low-intensity pulsed ultrasound in the treatment of fracture nonunion has been previously investigated, 1-6 and this technology is approved in the United States by the Food and Drug Administration (FDA) for treatment of fracture nonunion in adults. Several recent studies of this adjunctive treatment modality have included a percentage of scaphoid fractures. Nolte et al reported on 29 cases of established fracture nonunion in a variety of anatomic locations, including five scaphoid fractures. 3 The majority of these cases were treated with prior surgery. Following failure of treatment, the nonunions were subjected to ultrasound therapy; 86% went on to healing in a mean time of 22 weeks. Of the scaphoid nonunions, four out of five demonstrated healing at a mean interval of 143 days. Similarly, Gebauer et al reported on 67 nonunions, including six scaphoid nonunions, treated with ultrasound therapy. 1 Healing occurred in 85% of the patients without additional surgical treatment. Rubin et al analyzed ultrasound prescription registry data to examine the effects of ultrasound on nonunion. 4 The registry subcategorized fracture nonunion by anatomic location, and the reviewing authors found that 101 out of 118, or 86%, of scaphoid fracture nonunions healed following ultrasound therapy. Rubin et al did not assess the registry data for other Keywords ► scaphoid fracture ► scaphoid nonunion ► pulsed ultrasound ► adolescents ► adjunctive therapy AbstractBackground Treatment of scaphoid nonunion is challenging, leading clinicians to pursue innovation in surgical technique and adjunctive therapies to improve union rates. Purpose The purpose of this study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive treatment modality following surgical treatment of scaphoid nonunion in adolescent patients, for whom this therapy has not yet been FDA-approved. Patients and MethodsWe performed a retrospective review of adolescent patients with scaphoid nonunion treated surgically followed by adjunctive low-intensity pulsed ultrasound therapy. All patients underwent 20 minutes of daily ultrasound therapy postoperatively until there was evidence of bony healing, based on both clinical and radiographic criteria. Final healing was confirmed by > 50% bone bridging on CT scan. Results Thirteen of fourteen (93%) patients healed at a mean interval of 113 days (range 61-217 days). There were no surgical or postoperative complications. One patient developed heterotopic bone formation about the scaphoid. Conclusions Our study suggests that low-intensity pulsed ultrasound therapy can safely be utilized as an adjunctive modality in adolescents to augment scaphoid healing following surgical intervention. Level of Evidence Level IV, Case series

Effect of capsaicin-sensitive sensory neurons on bone architecture and mechanical properties in the rat hindlimb suspension model

“…HLS does not lead to additional bone loss after depletion of CGRP-positive nerve fibres by capsaicin treatment. A previous study [47] has demonstrated that sciactomy decreased the density of CGRP-positive nerve fibres in tibia fracture callus and resulted in low response of callus to ultrasound stimulation, which is well known in accelerating fracture healing in bone with normal innervations [48] .…”

Low-Intensity Pulsed Ultrasound for Nonoperative Treatment of Scaphoid Nonunions: A Meta-Analysis

“…We then carefully evaluated these 65 studies, and 5 studies ultimately met the inclusion criteria and were included in the final analysis. Of those studies excluded, 52 were unrelated to our eligibility criteria, and the other 8 were excluded for the following reasons: 2 studies only evaluated acute fractures (less than 3months old), 15,16,26,48 2 studies assessed the use of LIPUS immediately following surgery, 4,37 and 4 studies used the same U.S. Food and Drug Administration (FDA) data registry for data analysis (hence, only the most comprehensive studies were included). 9,25,39,47…”

Pulsed ultrasound for bone regeneration – outcomes and hurdles in the clinical application: a systematic review

“…A prescription of the LIPUS bonestimulators is usually advised when the surgical intervention carries high risks for the individual (Anderson et al, 2019;Leighton et al, 2017;Zura et al, 2015a). Thus, the to-date evidence for LIPUS effects on delayed-and non-unions (Table 2) mostly relies on either retrospective reports (Adukia et al, 2021;Carlson et al, 2015;Elvey et al, 2020;Farkash et al, 2015;Hemery et al, 2011;Lerner et al, 2004;Mayr et al, 2000;Nolte et al, 2001;Roussignol et al, 2012;Rutten et al, 2007;Teoh et al, 2018;Zura et al, 2015a) or observational studies without placebo controls (Bawale et al, 2020;Gebauer and Correll, 2005;Gebauer et al, 2005;Jones et al, 2006;Majeed et al, 2020;Moghaddam et al, 2016).…”