title: Low-intensity pulsed ultrasound for treating delayed union scaphoid fractures: case series.
abstract: BACKGROUND
  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; 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.
  
  
  METHODS
  During 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.
  
  
  RESULTS
  Overall, 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.
  
  
  CONCLUSIONS
  LIPUS 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.
authors.affiliation: Central Orthopedic Clinic, IDF, Zerifin, Israel. urifarkash@gmail.com.|Department of Orthopedic Surgery, Meir Medical Center, 59 Tchernihovsky St, Kfar-Saba, 44281, Israel. urifarkash@gmail.com.
authors.forename: Uri
authors.initials: U
authors.lastname: Farkash
authors.affiliation: Department of Orthopedic Surgery, Meir Medical Center, 59 Tchernihovsky St, Kfar-Saba, 44281, Israel. dr-bain@inter.net.il.
authors.forename: Orit
authors.initials: O
authors.lastname: Bain
authors.affiliation: Central Orthopedic Clinic, IDF, Zerifin, Israel. dr.gam@hotmail.com.
authors.forename: Arnon
authors.initials: A
authors.lastname: Gam
authors.affiliation: Department of Orthopedic Surgery, Meir Medical Center, 59 Tchernihovsky St, Kfar-Saba, 44281, Israel. nyska@internet-zahav.net.
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
authors.affiliation: Department of Orthopedic Surgery, Meir Medical Center, 59 Tchernihovsky St, Kfar-Saba, 44281, Israel. paulsagiv@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Sagiv
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D055815:Young Adult