Clinical and patient-reported outcomes following Low Intensity Pulsed Ultrasound (LIPUS, Exogen) for established post-traumatic and post-surgical nonunion in the foot and ankle.


Author: Majeed H1, Karim T2, Davenport J2, Karski M2, Smith R2, Clough TM3

Affiliation: <sup>1</sup>Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL England, United Kingdom. Electronic address: haroon.majeed@nhs.net.

<sup>2</sup>Wrightington Hospital, Hall Lane, Wigan, WN6 9EP England, United Kingdom.

<sup>3</sup>Wrightington Hospital, Hall Lane, Wigan, WN6 9EP England, United Kingdom. Electronic address: timothy.clough@wwl.nhs.uk.
Conference/Journal: Foot Ankle Surg.
Date published: 2019 May 19
Other:
  Pages: S1268-7731(19)30072-4   ,  Special Notes: doi: 10.1016/j.fas.2019.05.009. [Epub ahead of print]   ,  Word Count: 196  
    BACKGROUND: Biophysical methods including Low Intensity Pulsed Ultrasound (LIPUS) are emerging as potential alternatives to revision surgery for treating established nonunions. We aim to prospectively review the clinical and patient-reported outcomes of patients treated with LIPUS following post-traumatic and post-surgical nonunions in the foot and ankle.



METHODS: Forty-seven consecutive patients underwent Exogen treatment. Patient-reported outcome scores included MOXFQ, EQ-5D and VAS. Patients were divided in to 3 groups: fractures (A), hindfoot procedures (B) and midfoot/forefoot procedures (C).



RESULTS: Thirty-seven patients (78.7%) clinically united, 4 patients (8.5%) noticed no significant improvement but did not want further intervention and 6 patients (12.8%) underwent revision surgery. The mean duration of Exogen treatment was 6 months. Union rates of 93%, 67% and 78% were noted in the three groups. Significant improvement in functional outcomes and potential cost savings were observed.



CONCLUSIONS: Exogen for established nonunion in the foot and ankle is a safe, valuable and economically viable clinical option as an alternative to revision surgery. We observed better results in the fracture and midfoot/forefoot groups and relatively poorer results in the hindfoot fusion group.



Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.



KEYWORDS: Delayed union; Exogen; LIPUS; Nonunion



PMID: 31142440  DOI: 10.1016/j.fas.2019.05.009