SLR - June 2011 - Brandon Slade
Reference: Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. (2010). Shock Wave Therapy Compared with Intramedullary Screw Fixation for Nonunion of Proximal Fifth Metatarsal Metaphyseal-Diaphyseal Fractures. Journal of Bone and Joint Surgery, 92:846-54.
Scientific Literature Review
Reviewed by: Brandon Slade, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
Fracture nonunions in the metaphyseal-diaphyseal region of the fifth metatarsal have been a well known problem with reported prevalence as high as 44%. Shock wave therapy is an emerging technology, originally recognized for less invasive treatment for plantar fasciitis. More recently it has demonstrated effectiveness in the treatment of fracture nonunions. Given that complications associated with surgical intervention are not uncommon, the focus of this study was to determine whether shock wave therapy is a safe and effective technique for the treatment of fracture nonunions of the proximal fifth metatarsal compared with the “gold standard” of intramedullary screw fixation.
Methods:
This is a retrospective cohort study of all patients in whom an established nonunion of an acute fracture of the proximal part of the fifth metatarsal had been treated from August 1, 1999 to May 1, 2007. Twenty three patients were treated with electrohydraulic shock wave therapy by either the OssaTron device or the Orthowave-280 device compared to twenty patients treated with intramedullary screw fixation with either 6.5-mm cancellous screw, 4.5-mm cannulated screw, or a 4.5-mm non-cannulated screw. Both groups had no significant differences in demographics. The number of fractures that were healed at three and six months after treatment in each group was evaluated as well as any associated complications.
Results:
Twenty of twenty-three fractures (87%) in the shock wave group compared to eighteen of the twenty fractures (90%) in the fixation group had healed by three months after treatment. Twenty-one (91%) in the shock wave group compared to the same eighteen (90%) in the fixation group had healed by six months. All patients with healed nonunion fractures from both groups were able to return to pre-injury sporting or physical work activities. Only one patient in the shock wave group had a minor complication: transient petechiae self resolved within 24 hrs. Nine patients in the fixation group had a total of eleven complications: one case of cellulitis, nine cases of symptomatic hardware requiring removal, and one case of refracture.
Conclusions:
Shock wave therapy is an effective, less-invasive treatment for fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal, demonstrated in this study to be just as effective as intermedullary screw fixation with significantly less complications.