731 - Use of Radial Shock Wave Therapy for the Management of Nonunion of a Fifth Metatarsal Fracture - Case Report

A 41-year-old woman with a base of the fifth metatarsal non displaced fracture, diagnosed 3 months and 13 days prior, presented with persistent pain on the lateral aspect of the sole of the foot, limited stance and mobility, she also walked only with crutches despite initial immobilization and physical therapy. Imaging showed a non-displaced fracture at the tuberosity (Zone 1 according to Lawrence) with cortical discontinuity, indicating a bone nonunion. Radial shock wave therapy was administered in 8 sessions over 7 weeks (2000 shots, frequency 8-5 Hz, intensity 2.0-4.2 Bar). Following treatment, the patient reported complete pain relief, a significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) score from 56 to 100 points, she don't needed crutches to walk and she could run, also she showed advanced fracture consolidation on follow-up X-rays. Two and a half months after completing therapy, there was no recurrence of any symptoms.

Discussions:

Extracorporeal shock wave therapy (ESWT) is a noninvasive method used to address various musculoskeletal disorders. ESWT is primarily categorized into two types: focal and radial waves. While focal waves have been studied and established as effective for managing bone nonunion, a common complication with significant clinical and health system repercussion; radial shock waves have not been widely applied for this purpose. This case report highlights the successful treatment of a patient with nonunion of a fifth metatarsal fracture using radial shock waves.

Conclusions:

Nonunion is a frequent complication of fractures. The use of radial shock waves for managing this condition is proposed as a novel, effective, and noninvasive alternative, potentially increasing access to treatment and healing of these diseases. Further experimental studies are necessary to determine its effectiveness and safety.