Shock Waves in Scaphoid Pseudarthrosis: A Case Series

Technical | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 39-42 | Paul German Terán¹, Fidel Ernesto Cayon¹, Estefania Anabel Lozada¹, Alvaro Santiago Le Mari²

DOI: 10.13107/jrs.2022.v02.i01.47

Author: Paul German Terán [1], Fidel Ernesto Cayon [1], Estefania Anabel Lozada [1], Alvaro Santiago Le Marie [2]

[1] Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador.

[2] Department of General and Laparoscopic Surgery, Universidad Internacional del Ecuador, Quito, Ecuador.

Address of Correspondence
Dr. Paul German Terán,
Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito, Ecuador.
E-mail: paulteranmd@gmail.com

Abstract

Scaphoid fracture accounts for 60% of carpal fractures. The mechanism of fracture occurs after a fall with the hand extended, in pronation and radial or ulnar deviation in addition to the importance, they gain for their frequency; clinically, their problem lies in the high possibility of non-consolidation, due to the type of vascularization that it has, fractures located mainly in the waist and in the proximal pole are a high-risk factor. Most of the up-to-date papers available confirm a positive outcome of the use of focused extracorporeal shock wave therapy (ESWT-F) in pseudarthrosis. According to the literature, the success rate is between 50% and 91%. Complications when ESWT-F are performed by qualified personnel and following the standards established by international scientific organizations, are limited to petechiae and local hematomas having as a requirement, to be performed by trained personnel. This manuscript will discuss a series of cases treated in a certified center for the application of Focal Shock Waves between 2018 and 2021 to patients with scaphoid fracture with a diagnosis of Fracture Consolidation Delay and pseudarthrosis of scaphoids, which subjected to treatment with high-intensity focal shock waves under ultrasound guidance. We analyzed six male patients with an average age of 31.3 years who were treated with ESWT-F. About 33.3% were taken to osteosynthesis as initial management without achieving satisfactory bone consolidation; hence, ESWT-F was performed. About 0% complications were reported, bone consolidation occurred in 100% of patients on average of 6 weeks from the last session of ESWT-F. The results were clinically evaluated, where 100% of patients manifested a decrease in pain by an average of 75% at 2 weeks of the last session of ESWT-F and 100% at 12 weeks. In the imaging evaluation, the six patients (100%) showed signs of bone consolidation in the complete radiological assessment at 12 weeks and the Disabilities of the Arm, Shoulder, and Hand scale applied revealed improvement in their functional capacity.

Keywords: Scaphoid non-union, Delayed union, Extracorporeal shockwave therapy, Extracorporeal shock wave therapy, Pseudarthrosis, Disabilities of the arm, shoulder and hand

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