Huber et al. Journal of Medical Case Reports 2012, 6:209 http://www.jmedicalcasereports.com/content/6/1/209 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Successful treatment of nonunion in severe finger injury with low-intensity pulsed ultrasound (LIPUS): a case report Michaela Huber*, Lukas Prantl and Sebastian Gehmert Abstract Introduction: Severe injuries of the hand or single fingers require immediate treatment but surgical fixation methods are limited depending on soft tissue damage. Thus, it is very common that severe soft tissue damage along with poor osteosynthetic bone fixation results in a delayed healing process or nonunion. Low-intensity pulsed ultrasound (LIPUS) has been proven to stimulate bone formation in in vitro studies and also to significantly accelerate nonunion healing in animal studies and clinical trials but to date there are no data with respect to nonunion in phalanx fracture. Case presentation: We report a case in which we successfully used LIPUS in a 19-year-old Caucasian man with a nonunion of his ring finger after injury and first treatment with K-wire osteosynthesis. Conclusion: We recommend that LIPUS be considered as an option to treat nonunions in fractures of the hand, especially because it is a soft tissue conserving method with a good functional result. Introduction In recent years, low intensity pulsed ultrasound (LIPUS) has been the focus of several studies examining how to help stimulate bone formation in fractures and non- unions [1-3]. However, to the best of our knowledge, there have been no reported studies dealing with the use of LIPUS to treat fractures or nonunion of the fingers. Up to now in cases of nonunions, trauma surgeons have had to perform additional surgery with a more stable osteosynthesis and bone grafting. This can cause additional complications to the already pre-damaged soft tissue with further loss of function [4,5]. In this case we successfully used LIPUS, a non invasive treatment, to in- vestigate its applicability in treating nonunion of fingers. Case presentation A 19-year-old Caucasian man was admitted to our emer- gency department with a critical ischemia of his right ring finger due to a crushing injury. His finger had been caught between a car and a car-jack while he was work- ing as a mechanic. The first physical examination of the * Correspondence: michaela1.huber@ukr.de Department of Trauma, Plastic & Hand Surgery, University Medical Center Regensburg, Regensburg, Germany ring finger revealed an open wound of 3 cm on the dor- sal side of the middle phalanx. Edges of the wound reached the ulnar and radial digital neurovascular bundle. The patient reported decreased sensibility of the end phal- anx including painful range of motion (ROM) but without loss of function of all tendons. We found a restricted fin- ger blood flow detected by nail bed compression in com- parison with the uninjured fingers. An X-ray showed an undislocated transverse fracture of the middle phalanx (Figure 1a). The patient was immediately transferred to the operating room (OR) where the wound was examined. Severe damage of the surrounding soft tissue was seen. Microscopic examination revealed no defect of the crushed vessels, the radial digital nerve was intact, but an epineural lesion was apparent for the ulnar digital nerve. A minimal osteosynthesis with two Kirschner-wires (K- wires) was performed. X-ray imaging showed an anatom- ical retention and fixation of the fracture (Figure 1b). The dorsal wound of the ring finger was cut out and sutured. The patient was discharged from the hospital on the fourth day without any sign of wound healing disturbance. The ring finger was immobilized with a finger splint in- cluding the proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP). © 2012 Huber et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.