Authors (including presenting author) :
Ng DMT, Luk MLM, Lam ICY, Cho JSY, Chow IHW, Chan ACM
Affiliation :
Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Scaphoid fracture is the most common type, constituting 70 to 80%, of carpal fractures. Nonunion is a frequently seen complication after scaphoid fracture accounting for its tenuous distal blood perfusion of the bone. With the estimated nonunion rates varies from 5 to 21%, nonunion of scaphoid definitely could result in serious impairment of wrist function and osteoarthritis. In addition, scaphoid fracture is usually found in young and active individuals, any delayed union or nonunion can possibly lead to significant psychological and financial consequences. Pulsed Electromagnetic Field (PEMF) was used in the treatment of accelerating fracture healing and reduction in nonunion rate by constituting an exogenous method for cell and tissue modification in delayed or nonunion tibial fracture. Its beneficial effect for the management of scaphoid fracture has to be investigated.
Objectives :
To investigate the effects of pulsed electromagnetic field on 1) promoting bone healing, 2) reducing nonunion rate and 3) improving physical function of patients with fractured scaphoid.
Methodology :
This prospective study evaluated subjects aged 18 or above and with scaphoid fracture, which was either treated conservatively or operatively, receiving physiotherapy treatment at Queen Elizabeth Hospital. In addition to the conventional physiotherapy management program for scaphoid fracture, all subjects received PEMF treatment within the first week after discharge from hospital for promoting bone healing. Daily PEMF treatment was offered on weekdays until confirmation of fracture healed when medical follow-up. Information on 1) bone growth - healing status and reports of nonunion, 2) physical function- pain level on Numeric Pain Rating Scale (NPRS), handgrip strength and Disability of Arm, Shoulder and Hand Questionnaire (DASH) were recorded at baseline (except handgrip strength was only measured when fracture healed) and 1 year after.
Result & Outcome :
Twenty seven subjects (21 males) aged 39.9±10.43 years old were analyzed. Seventeen subjects underwent operative interventions whereas the remaining ten subjects were treated conservatively. The average time for complete fractured scaphoid healing was 15.4 and 17.3 weeks for operative and conservative management respectively. Percentage of injured to non-injured handgrip strength was significantly improved from 53.3% to 87.4% (p<0.001). Pain intensity level on NPRS and the result of DASH reduced significantly from 8.2 to 3.2 (p<0.001) and from 76% to 24.1% (p<0.001) respectively. This study showed improved clinical outcomes in regard of pain control and physical functions for patients suffered from scaphoid fracture. The application of PEMF might be considered as an adjunct to conventional physiotherapy on fracture management in terms of stimulation of bone healing.
Co-location with:
