title: Low-intensity pulsed ultrasound treatment as an alternative to vascular bone graft surgery for a 5-year-long ulnar non-union in a patient with haemochromatosis.
abstract: We present the case of a 75-year-old woman with haemochromatosis who developed a 5-year-long right ulnar non-union after a shortening osteotomy to correct a malunited Colles' fracture. Standard surgical treatment for ulnar non-unions was attempted on 19 March 2008 and again on 20 April 2009, but the non-union persisted on 8 May 2012, as confirmed by CT scan. Vascular bone grafting and refixation was then considered, but the patient declined this extensive operation, instead choosing to try non-invasive low-intensity pulsed ultrasound treatment with an Exogen device. Just 4 months later, complete union as confirmed by CT scan was achieved. This is the first case demonstrating the efficacy of ultrasound treatment for long-standing non-unions resistant to surgery in patients with haemochromatosis, a disorder where iron deposition can provide suboptimal circumstances for bone healing. Our finding suggests that low-intensity pulsed ultrasound devices could be used as a first-line treatment for stable non-unions instead of revision surgery.
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Sebastian Daniel
authors.initials: SD
authors.lastname: Povlsen
authors.affiliation: Faculty of Medicine, London Hand Clinic, London, UK.
authors.forename: Bo
authors.initials: B
authors.lastname: Povlsen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D005599:Fractures, Ununited / Q000209:etiology / Q000628:therapy*; D006432:Hemochromatosis / Q000150:complications*; D006801:Humans; D014458:Ulna Fractures / Q000150:complications* / Q000601:surgery; D014464:Ultrasonic Therapy; D000069453:Ultrasonic Waves