Extracorporeal Shock Wave Therapy for Delayed Diagnosis of Proximal Radial Head Fracture with Nonunion: A Case Report

體外震波使用於延誤診斷之未癒合近端橈骨頭骨折：個案研究報告

林羿辰(YI-Chen Lin) ； 魏大森(Ta-Sen Wei)

《台灣復健醫學雜誌》 49卷1期 (2021/06) Pp. 113-117

https://doi.org/10.6315/TJPMR.202106_49(1).0010

摘要

Fracture of the proximal radial head is the most common elbow fracture. However, a non-displaced proximal radial head fracture may be overlooked on plain radiographs. This case report describes a 52-year-old female patient who sustained a right elbow injury after a traffic accident, with delayed diagnosis of radial head fractures and subsequent nonunion. After 10 sessions of focal extracorporeal shock wave therapy (ESWT), the pain and range of motion improved and a sequential x-ray revealed smooth cortical bone and increased density of the proximal radial head. This report reveals that (1) non-displaced proximal radial head fractures can be overlooked on plain radiographs, (2) musculoskeletal ultrasound should be performed if symptoms persist, and (3) ESWT appeared to result in excellent bone healing in a nonunion fracture.

關鍵字

non-union ； radial head fracture ； non-displaced fracture ； extracorporeal shock wave therapy ； ESWT

並列摘要

橈骨頭骨折是手肘骨折裡面最常見的，占了所有手肘骨折的三分之一。然而，位於此處未移位的骨折在X光下很容易被遺漏，早期超音波介入診斷可以更精確的診斷出骨折。本次案例為一位52歲的女性，因車禍傷到右手肘，於急診照的X光並未看出骨折。三個月後因疼痛及活動角度受限，患者來到復健科門診，超音波及X光檢查診斷出橈骨頭骨折合併骨折處不癒合。後續患者於門診接受十次的聚焦式震波治療，並於後續的X光可看到皮質骨癒合及骨密度增加。本個案研究結論:（1）未移位的骨折在X光之下容易被遺漏，早期的超音波檢查可協助早期診斷。（2）震波治療對於骨折未癒合的病人治療效果是非常好的。

並列關鍵字

不癒合（non-union） ； 橈骨頭骨折（radial head fracture） ； 不移位的骨折（non-displaced fracture） ； 震波治療（extracorporeal shock wave therapy, ESWT）

參考文獻

Kodde IF, Kaas L, Flipsen M, et al. Current concepts in the management of radial head fractures. World J Orthop 2015; 6: 954.

McNamara IR and Davidson JA. The delayed diagnosis of radial head fractures. Eur J Emerg Med 2005; 12: 39-40.

Golinvaux NS, Labrum IV JT, Lee DH, et al. Symptomatic Radial Neck Nonunion Following Traumatic Impacted Radial Neck Fracture. J Hand Surg Am 2020; 45: 453.

Pappas N and Bernstein J. Fractures in brief: radial head fractures. Clin Orthop Relat Res 2010; 468: 914-6

Willems A, van der Jagt OP and Meuffels DE. Extracorporeal shock wave treatment for delayed union and nonunion fractures: A systematic review. J Orthop Trauma 2019; 33: 97-103.