Low-intensity pulsed ultrasound treatment for scaphoid fracture nonunions in adolescents.

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 2 3 4 5 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 fracture nonunion–related treatment (bracing, cast, bone grafting, internal fixation, etc.). Only one study has limited the scope of investigation of ultrasound therapy to scaphoid nonunion specifically. Ricardo et al performed a double-blinded randomized controlled trial of the effect of ultrasound on scaphoid nonunion healing following surgical treatment with vascularized pedicle bone grafting.7 This study compared time to healing using clinical and radiographically defined criteria in 21 patients randomized to either ultrasound therapy or placebo therapy following surgical treatment. The investigators found a statistically significant reduction in time to healing in the intervention group: the average time to healing was 56 days in the ultrasound group versus 94 days in the control group. All patients were male and had an average age of 26.7 years, with the youngest being 17 years old. No further breakdown of patient demographics was published. The purpose of the present study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive therapy after surgical treatment of scaphoid nonunions in adolescent patients, as this modality has not been approved by the FDA for this purpose in this patient population (only for adults).