1900 - Non-Invasive Management of Tibial Nonunion Using Focused Extracorporeal Shockwave Therapy: A Case Report

Case Diagnosis: We present the case of a 15-year-old male with a history of bilateral cavovalgus foot deformities, grade 2 left foot with supination, unstable gait, and hind‑foot varus; grade 1 right foot with mild hind‑foot valgus who developed a postoperative tibial non‑union after a mild infection of the left foot.

Case Description: The patient underwent simultaneous corrective foot surgery on 27 July 2023. The right foot recovered without complication, achieving complete clinical resolution. The left foot experienced a mild postoperative infection, resulting in delayed bone healing and tibial non‑union. Initially the patient reported weight‑bearing pain and required a walking boot and axillary crutches. As a non-surgical alternative to promote osseous consolidation, focused extracorporeal shockwave therapy (FESWT) was initiated. Using a Storz Medical T‑TOP F‑SW ULTRA device, eight sessions were delivered over two weeks (6,000 impulses per session, energy flux density 0.55 mJ/mm², frequency 4 Hz) targeting four ultrasound‑guided anatomical sites. Topical anesthetic pads were applied four hours before each session.

Discussions: FESWT delivers mechanical micro‑trauma that promotes angiogenesis, osteoblastic activity, and callus formation, offering a biologically active alternative to revision surgery. After eight weeks, the patient achieved painless full weight‑bearing, and radiographs showed new tibial bone formation compared with baseline. These outcomes align with growing evidence that focused shockwave therapy can accelerate healing of long‑bone non‑unions, especially in settings where additional surgery is undesirable or resources are limited.

Conclusions: This is the first reported use of focused ESWT for tibial non‑union management in the Dominican Republic. The treatment resulted in successful osseous consolidation and functional recovery, highlighting FESWT as a promising, non‑invasive therapeutic modality for long‑bone non‑unions and a means to reduce the need for further surgical intervention.