Successful Use of Low-intensity Pulsed Ultrasound in the Rescue of Failed Vascularised Fibular Graft for Radial Non-union

Abstract

We present the case of a 47-year-old man who developed a non-union of the left radius following an open double barrel fracture to the left forearm sustained in a road traffic accident. Whilst initially treated with internal fixation, only the ulna fracture united. The patient then underwent two failed radial non-union revision surgeries with exchange of plate and simple bone grafting. A third attempt to rescue the non-union was made with a vascularised bone graft, using a composite fibula/skin free flap. However, within one week the vascular anastomosis failed, and the whole free flap, except the no longer vascularised fibular graft, was excised. Given the previous surgical failures, adjunctive use of low-intensity pulsed ultrasound treatment was started and led to union 6 months later. We report that as an adjunct to union low-intensity pulsed ultrasound treatment can succeed where multiple previous bone grafts alone for non-unions failed, including a vascularised bone graft in which its vascular anastomosis was subsequently compromised.