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

Abstract

Background 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 Methods We 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

Keywords

scaphoid fracture - scaphoid nonunion - pulsed ultrasound - adolescents - adjunctive therapy

^* Joseph F. Slade III passed away in May 2010

• References

• 1 Gebauer D, Mayr E, Orthner E, Ryaby JP. Low-intensity pulsed ultrasound: effects on nonunions. Ultrasound Med Biol 2005; 31 (10) 1391-1402
• 2 Jingushi S, Mizuno K, Matsushita T, Itoman M. Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures. J Orthop Sci 2007; 12 (1) 35-41
• 3 Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 2001; 51 (4) 693-702 , discussion 702–703
• 4 Rubin C, Bolander M, Ryaby JP, Hadjiargyrou M. The use of low-intensity ultrasound to accelerate the healing of fractures. J Bone Joint Surg Am 2001; 83-A (2) 259-270
• 5 Rutten S, Nolte PA, Guit GL, Bouman DE, Albers GH. Use of low-intensity pulsed ultrasound for posttraumatic nonunions of the tibia: a review of patients treated in the Netherlands. J Trauma 2007; 62 (4) 902-908
• 6 Watanabe Y, Matsushita T, Bhandari M, Zdero R, Schemitsch EH. Ultrasound for fracture healing: current evidence. J Orthop Trauma 2010; 24 (Suppl. 01) S56-S61
• 7 Ricardo M. The effect of ultrasound on the healing of muscle-pediculated bone graft in scaphoid non-union. Int Orthop 2006; 30 (2) 123-127
• 8 Waitayawinyu T, McCallister WV, Katolik LI, Schlenker JD, Trumble TE. Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg Am 2009; 34 (3) 387-394
• 9 Chapman IV, MacNally NA, Tucker S. Ultrasound-induced changes in rates of influx and efflux of potassium ions in rat thymocytes in vitro. Ultrasound Med Biol 1980; 6 (1) 47-58
• 10 Hadjiargyrou M, McLeod K, Ryaby JP, Rubin C. Enhancement of fracture healing by low intensity ultrasound. Clin Orthop Relat Res 1998; (355, Suppl): S216-S229
• 11 Parvizi J, Wu C-C, Lewallen DG, Greenleaf JF, Bolander ME. Low-intensity ultrasound stimulates proteoglycan synthesis in rat chondrocytes by increasing aggrecan gene expression. J Orthop Res 1999; 17 (4) 488-494
• 12 Yang K-H, Parvizi J, Wang S-J , et al. Exposure to low-intensity ultrasound increases aggrecan gene expression in a rat femur fracture model. J Orthop Res 1996; 14 (5) 802-809
• 13 Rawool NM, Goldberg BB, Forsberg F, Winder AA, Hume E. Power Doppler assessment of vascular changes during fracture treatment with low-intensity ultrasound. J Ultrasound Med 2003; 22 (2) 145-153
• 14 Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg Br 1985; 67 (4) 650-655
• 15 Munk B, Larsen CF. Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion. Acta Orthop Scand 2004; 75 (5) 618-629
• 16 Caputo AE, Watson HK, Nissen C. Scaphoid nonunion in a child: a case report. J Hand Surg Am 1995; 20 (2) 243-245
• 17 Chloros GD, Themistocleous GS, Wiesler ER, Benetos IS, Efstathopoulos DG, Soucacos PN. Pediatric scaphoid nonunion. J Hand Surg Am 2007; 32 (2) 172-176
• 18 Littlefield WG, Friedman RL, Urbaniak JR. Bilateral non-union of the carpal scaphoid in a child. A case report. J Bone Joint Surg Am 1995; 77 (1) 124-126
• 19 Maxted MJ, Owen R. Two cases of non-union of carpal scaphoid fractures in children. Injury 1982; 13 (5) 441-443
• 20 Mintzer CM, Waters PM. Surgical treatment of pediatric scaphoid fracture nonunions. J Pediatr Orthop 1999; 19 (2) 236-239
• 21 Onuba O, Ireland J. Two cases of non-union of fractures of the scaphoid in children. Injury 1983; 15 (2) 109-112
• 22 Pick RY, Segal D. Carpal scaphoid fracture and non-union in an eight-year-old child. Report of a case. J Bone Joint Surg Am 1983; 65 (8) 1188-1189
• 23 Southcott R, Rosman MA. Non-union of carpal scaphoid fractures in children. J Bone Joint Surg Br 1977; 59 (1) 20-23
• 24 Duteille F, Dautel G. Non-union fractures of the scaphoid and carpal bones in children: surgical treatment. J Pediatr Orthop B 2004; 13 (1) 34-38
• 25 Fabre O, De Boeck H, Haentjens P. Fractures and nonunions of the carpal scaphoid in children. Acta Orthop Belg 2001; 67 (2) 121-125
• 26 García-Mata S. Carpal scaphoid fracture nonunion in children. J Pediatr Orthop 2002; 22 (4) 448-451