Huber et al. Journal of Medical Case Reports 2012, 6:209 http://www.jmedicalcasereports.com/content/6/1/209 success, so we decided to use LIPUS instead of bone graft- ing and osteosynthesis. LIPUS is a pain free therapy performed daily at home by the patient with the possibility of avoiding a second surgical procedure. This out-patient treatment reduces the length of hospital stays for patients and the expenses of the health care system [13]. Conclusion We report successful ultrasound treatment after inad- equate bone healing with insufficient stability of the middle phalanx. The patient suffered from reduced ROM in the DIP and PIP joints. The patient also had an ulnar deviation associated with pain owing to the in- stability of the fracture. Based on this case report we suggest LIPUS as a possible approach for nonunion in finger injuries, however further clinical trials are neces- sary to confirm these preliminary findings. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions MH was the main author and performed the clinical assessment, follow-up and the bibliographic research. LP performed the clinical assessment, the surgery and the follow-up. SG was a major contributor in writing the manuscript. All authors have read and approved the final manuscript. Received: 14 February 2012 Accepted: 18 July 2012 Published: 18 July 2012 References 1. Griffin XL, Costa ML, Parsons N, Smith N: Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev 2012 Feb15, 2:CD008579. 2. Siska PA, Gruen GS, Pape HC: External adjuncts to enhance fracture healing: what is the role of ultrasound? Injury 2008, 39:1095–1105. 3. Watanabe Y, Matsushita T, Bhandari M, Zdero R, Schemitsch EH: Ultrasound for fracture healing: current evidence. J Orthop Trauma 2010, 24:S56–S61. 4. Whitney TM, Lineaweaver WC, Buncke HJ, Nugent K: Clinical results of bony fixation methods in digital replantation. J Hand Surg 1990, 15:328–334. 5. Wolfe SW, Otchkiss RN, Pederson WC, Scott KH: The mangled upper extremity. In Greens Operative Handsurgery Vol 1. 6th edition. Philadelphia: Elsevier Churchill Livingstone; 2010:1603–1644. 6. Freeland AE, Lineaweaver WC, Lindley SG: Fracture fixation in the mutilated hand. Hand Clin 2003, 19:51–61. 7. Ring D: Malunion and nonunion of the metacarpals and phalanges. Instr Course Lect 2006, 55:121–128. 8. Gebauer D, Mayr E, Orthner E, Ryaby JP: Low-intensity pulsed ultrasound: effects on nonunions. Ultrasound Med Biol 2005, 31:1391–1402. 9. Reher P: Elbeshir el-NI, Harvey W, Meghji S, Harris M: The stimulation of bone formation in vitro by therapeutic ultrasound. Ultrasound Med Biol 1997, 23:1251–1258. 10. Malizos KN, Hantes ME, Protopappas V, Papachristos A: Low-intensity pulsed ultrasound for bone healing: an overview. Injury 2006, 37:S56–S62. Page 3 of 3 11. Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH: Low- intensity pulsed ultrasound in the treatment of nonunions. J Trauma 2001, 51:693–702. 12. Mayr E, Frankel V, Rüter A: Ultrasound-an alternative healing method for nonunions? Arch Orthop Trauma Surg 2000, 120:1–8. 13. Heckman JD, Sarasohn-Kahn J: The economics of treating tibia fractures. The cost of delayed unions. Bull Hosp Jt Dis 1997, 56:63–72. doi:10.1186/1752-1947-6-209 Cite this article as: Huber et al.: Successful treatment of nonunion in severe finger injury with low-intensity pulsed ultrasound (LIPUS): a case report. Journal of Medical Case Reports 2012 6:209. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit