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Shock wave therapy may be effective for nonunions of the metaphyseal-diaphyseal region of fifth metatarsal
Furia JP. JBJS. 92:846-854. April 2010. doi:10.2106/JBJS.I.00653
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Recent research has shown that intramedullary screw fixation and shock wave therapy are effective treatments for nonunions of the metaphyseal-diaphyseal region of the fifth metatarsal. However, screw fixation more commonly produces complications that often require additional surgery.
“The current ‘gold standard’ for treatment of chronic fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal is intramedullary screw fixation,” John P. Furia, MD, and colleagues wrote in their abstract. They also noted that complications related to intramedullary screw fixation are common.
For their study, the investigators examined the safety and efficacy of shock wave therapy as a treatment for these nonunions. Their study included 23 patients who received high-energy shock wave therapy (2000 to 4000 shocks with an energy flux density per pulse of 0.35 mJ/mm2). Twenty patients received intramedullary screws. At 3 and 6 months, the investigators recorded how many fractures had healed. They also noted treatment-related complications.
At 3 months, the investigators found that 20 of 23 nonunions in the shock wave group had healed; one of these nonunions went on to heal by 6 months. The investigators discovered that 18 of the 20 nonunions in the screw fixation group had healed by 3 months.
The lone complication in the shock wave group involved post-treatment petechiae. There were 11 complications in the screw fixation group: one refracture, one case of cellulites and nine cases of symptomatic hardware, according to the abstract.