Abstract
Category:
Lesser Toes; Trauma
Introduction/Purpose:
It has been reported that fractures of interphalangeal coalition often result in delayed union or nonunion. Although there are scattered reports of surgical treatment of painful nonunion after fractures of the interphalangeal coalition, there is currently lack of data on the efficacy of extracorporeal shock wave therapy (ESWT) for nonunion of fractures of the interphalangeal coalition. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy for patients with painful nonunion of fractures of the interphalangeal coalition.
Methods:
A total of 7 patients (7 feet) diagnosed with painful nonunion due to persistent pain and no tendency toward bony fusion at least 3 months after fracture of the interphalangeal coalition from 2022 to 2023 were included in this study. Focused ESWT was performed in all patients. There were 2 males and 5 females with a mean age of 51.3 years (range, 23-62). The fourth toe was present in two cases, and the fifth toe in five cases. The mean time from the date of injury to the start of ESWT was 3.8 months (range, 3-5 months). 4000 shots at 0.25 mJ/mm2 (4 Hz) was administered at 2-week intervals. Visual analog scale (VAS) before and after ESWT were recorded.
Results:
The attainment of complete bony union was documented in all seven patients (Figure 1). The application of focused ESWT was carried out a mean of 2.8 times (range, 2-4 times), and the mean duration from the initiation of treatment to the confirmation of bony union was 1.8 months (range, 1-2 months). In all cases, the symptoms of swelling and pain were successfully alleviated. The VAS scores exhibited a significant improvement, with the mean VAS score decreasing from 3.9 (range, 2-6) before ESWT to 0 after the achievement of union.
Conclusion:
Fractures occurring at interphalangeal coalitions have been reported to require a considerable amount of time for bony union, and surgical intervention has been reported in cases of painful nonunion. However, in the present study, all 7 cases of painful nonunion achieved complete bony fusion following focused ESWT. Moreover, bony union was observed within just 2 months of the start of ESWT. These findings suggest that focused ESWT is a valuable treatment option for achieving bony fusion in cases of painful nonunion of fractures at the interphalangeal coalitions.
