From the Guidelines
The most minimally invasive technique for addressing a Lapidus nonunion one year after surgery is low-intensity pulsed ultrasound (LIPUS) therapy, as it has been approved by the US Food and Drug Administration (FDA) for fracture healing and non-union treatment since 1994 and 2000, respectively 1. This approach is supported by guidance from the UK National Institute for Health and Care Excellence (NICE) in 2010, which issued a statement supporting the use of LIPUS to reduce fracture healing time and provide clinical benefit, particularly in circumstances of delayed healing and non-union 1. Some key points to consider when using LIPUS therapy include:
- The device should be used for 20 minutes daily for 3-6 months to stimulate osteoblastic activity
- LIPUS therapy can be used in conjunction with other treatments, such as pain management with NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks
- Weight-bearing restrictions should be maintained until radiographic evidence of healing appears, usually within 2-3 months after treatment
- If the nonunion is unstable or has significant hardware failure, LIPUS therapy may be insufficient, and revision surgery with bone grafting might be necessary The use of LIPUS therapy has been widely adopted, with a Canadian survey of 450 trauma surgeons in 2008 finding that nearly half of respondents were using bone stimulators to manage tibial fractures, and about half of those used LIPUS 1. Overall, LIPUS therapy is a minimally invasive and effective treatment option for addressing Lapidus nonunion one year after surgery, with a strong evidence base supporting its use 1.
From the Research
Minimally Invasive Techniques for Lapidus Nonunion
- Low-intensity pulsed ultrasound (LIPUS) has been shown to be an effective treatment for nonunions, with healing rates averaging 87% 2.
- LIPUS is a noninvasive technique that uses pulsed waves to stimulate bone healing, with minimal thermal effects 3.
- The use of LIPUS for stimulation of bone healing has been reviewed, with evidence suggesting its effectiveness in accelerating fracture repair and healing of nonunions 4.
- In vitro studies have also shown that LIPUS can promote osteogenic differentiation of nonunion tissue-derived cells, induced by bone morphogenetic protein 7 (BMP-7) 5.
- A case report has described a minimally invasive surgical technique for trapezoid nonunion, using a dorsal approach and percutaneous drilling to freshen the fracture ends, followed by fixation with a cannulated headless compression screw 6.
Comparison of Techniques
- LIPUS is a noninvasive technique that can be used to stimulate bone healing, while minimally invasive surgery may be necessary in some cases to freshen the fracture ends and stabilize the nonunion.
- The choice of technique will depend on the individual case and the severity of the nonunion, as well as the patient's overall health and medical history.
- Further research is needed to compare the effectiveness of LIPUS and minimally invasive surgery for the treatment of lapidus nonunion.