Bone union achieved in an ulnar shaft nonunion using dextrose prolotherapy without surgery: a case report

Prolotherapy, involving hypertonic dextrose injections to stimulate growth factor release and promote tissue healing, has recently gained attention as a regenerative treatment for refractory musculoskeletal conditions. We report a 54-year-old man with a painful ulnar shaft nonunion after a karate injury. Conservative treatment failed over 12 months, and he presented with persistent pain (numeric rating scale [NRS] score 6). Ultrasound-guided prolotherapy using a 30% dextrose solution was performed in five sessions at 2-3 week intervals. Callus formation was noted at 4 weeks, pain completely resolved (NRS score 0), and the patient resumed karate at 12 weeks. Radiographic union was confirmed at 15 weeks without immobilization or surgery. This case highlights prolotherapy's potential as a minimally invasive and effective alternative to surgery for painful nonunion.