Low Intensity Pulsed Ultrasound (LIPUS) For Delayed Unions and Non-Unions After Elective Foot and Ankle Procedures

Description

In this presentation, Annika Kicera, a fifth-year medical student from UCL, discusses a project aimed at evaluating the efficacy of low intensity pulsed ultrasound (EXOGEN) in treating delayed unions and non-unions following elective foot and ankle surgeries. Annika outlines that while current NICE guidelines recommend EXOGEN for non-unions persisting beyond nine months after long bone fractures, there is a lack of specific guidance related to elective foot and ankle procedures.



The project involved reviewing 108 patients who received EXOGEN therapy between October 2011 and November 2020. Out of these, 64 patients had undergone elective procedures, and after excluding three due to insufficient data, a final cohort of 61 patients was analyzed. The findings include 29 cases of delayed unions and 32 of non-unions, with the majority arising from midfoot surgeries. Successful outcomes were defined as radiological evidence of union combined with pain improvement, revealing that only 24.59% of the patients achieved radiological union through EXOGEN treatment.



Interestingly, the success of EXOGEN varied by foot region, with the forefoot showing the highest success rate, while the midfoot exhibited the least effectiveness. Additionally, the timing of EXOGEN application post-surgery impacted its success; starting treatment sooner yielded better outcomes. If the NICE guidelines were adhered to, with treatment initiation after nine months, the study suggests no cases would have achieved union.



In conclusion, the study indicates that low intensity pulsed ultrasound (EXOGEN) is not an effective treatment for delayed unions and non-unions following elective foot and ankle surgeries. Annika opens the floor for questions after her presentation.

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