Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy

Haffner, Nicolas; Antonic, Vlado; Smolen, Daniel; Slezak, Paul; Schaden, Wolfgang; Mittermayr, Rainer; Stojadinovic, Alexander

doi:10.1016/j.injury.2016.04.010

Cited by 46 publications

(52 citation statements)

References 59 publications

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“…Additional surgical therapy including multiple exchange nailing, additional open approach with autologous bone grafting, secondary dynamization and compression of the inlaying exchange nail, or additional conservative treatment such as ESWT [34] may be necessary in cases, in which nonunion healing was clinically and radiologically prolonged.…”

Section: Discussionmentioning

confidence: 99%

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Hierholzer

Friederichs

Glowalla

et al. 2016

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. Methods This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term followup was analyzed for rate of bone healing and functional outcome. Results Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Discussion Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Hierholzer

Friederichs

Glowalla

et al. 2016

International Orthopaedics (SICOT)

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“…УВТ оказывают положительное воздействие на регенерацию костной ткани и способствуют достижению анальгезирующего эффекта при переломах костей, в основном трубчатых [22,23]. Стимулирующий регенерацию эффект при переломах костей оказывают расфокусированные средне-и низкоэнергетические ударно-волновые импульсы с параметрами волны: давление 1,5-2,5 атм, частота 4-8 Гц.…”

Section: Discussionunclassified

“…Успех лечения контролировался рентгенограммами и клиническими исследованиями. УВТ, повидимому, является эффективной и безопасной альтернативой в лечении трещин и поверхностных переломов костей при раннем диагностировании [22,23,24,25].…”

Section: Discussionunclassified

Shock Wave Therapy for Osteoarthritis of the Knee

Гунин¹,

Polyakova²,

Matveeva³

2019

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“…11 Los mejores resultados del tratamiento de la seudoartrosis con oCEC se han documentado para seudoartrosis "hipertróficas". [11][12][13] El objetivo de este estudio fue investigar el efecto de la terapia con oCEC sobre un foco de seudoartrosis "atrófi-ca" generado en tibia de conejo.…”

Section: Introductionunclassified

Seudoartrosis atrófica. Efecto de la aplicación de ondas de choque extracorpóreas en un modelo experimental en tibia de conejos. [Atrophic pseudoarthrosis. Effect of extracorporeal shock waves aplication in an experimental model in tibia of rabbits].

Vecchio¹,

Serra

Gallino³

et al. 2017

Rev. Asoc. Arg. Ort. y Traumatol

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ResumenIntroducción: Los efectos de las ondas de choque extracorpóreas se han investigado en osteoblastos humanos, focos fracturarios, seudoartrosis y células periósticas. Los mejores resultados del tratamiento de la seudoartrosis con ondas de choque extracorpóreas se han documentado para seudoartrosis hipertróficas. El objetivo de este estudio fue investigar el efecto de la terapia con ondas de choque extracorpóreas sobre un foco de seudoartrosis "atrófica" generado en tibia de conejo. Métodos: Se establecieron tres grupos: A, fracturados sometidos a ondas de choque extracorpóreas; B ("control"), fracturados no sometidos a ondas de choque y C, no fracturados (pierna derecha). Se trataron 37 conejos (cuniculus NV) blancos y esqueléticamente maduros de Nueva Zelanda. Se practicó la cauterización del periostio con electrobisturí bipolar en una extensión de 20 mm, en ambos muñones óseos (proximal y distal). Luego se aplicaron ondas de choque extracorpóreas en una sola sesión. Se realizaron tinciones con hematoxilina-eosina. Se efectuó el análisis biomecánico con un método de carga a "3 puntos". Se estudiaron la carga máxima aplicada y el módulo de elasticidad para cada grupo. Resultados: El estudio histológico permitió registrar signos de consolidación -callo fracturario perióstico y endostalconsiderablemente mayores en las tibias de los animales del grupo A (tratado con ondas de choque extracorpóreas) que en las del grupo B "control". Conclusión: En un modelo experimental original de seudoartrosis atrófica generada por electrocauterización en tibia de conejos, se registraron cambios significativos radiográficos e histológicos luego de la intervención del foco mediante ondas de choque extracorpóreas. 322Abstract Introduction: The effects of extracorporeal shock wave therapy (ESWT) have been investigated in human osteoblasts, fracture foci, nonunion and periosteum cells. The best results of nonunion treatment with ESWT have been documented for hypertrophic type. The objective of this study was to investigate the effects of ESWT in an atrophic nonunion focus generated in a rabbit tibia model. Methods: Three groups were included: A, fractures receiving ESWT; B ("control"), fractures not receiving ESWT, and C, no fractures (right leg). A total of 37 New Zealand white and skeletally mature rabbits (cuniculus NV) were treated. Periosteum was cauterized using bipolar electrocautery at 20 mm in both bone stumps (proximal and distal). Then ESWT was applied in one session. Staining with hematoxylin-eosin was used. A biomechanical analysis with a 3-point loading system was performed. Maximum load and elastic modulus were evaluated in each group. Results: histological study evidenced signs of union (periosteal and endosteal fracture callus) which were considerably larger in tibias of Group A (treated with ESWT) as compared to the control group (Group B). Conclusion:In an experimental model of atrophic pseudarthrosis caused by electrocautery in tibias of rabbits, significant radiographic and histological changes were observed ...

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Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy

Cited by 46 publications

References 59 publications

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Shock Wave Therapy for Osteoarthritis of the Knee

Seudoartrosis atrófica. Efecto de la aplicación de ondas de choque extracorpóreas en un modelo experimental en tibia de conejos. [Atrophic pseudoarthrosis. Effect of extracorporeal shock waves aplication in an experimental model in tibia of rabbits].

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