Extracorporeal shock wave treatment in nonunions of long bone fractures

Abstract

We reviewed the clinical results of the past 7 years in order to investigate the effect of extracorporeal shock wave therapy (ESWT) in nonunions of long bone fracture. Sixty-nine patients with 69 nonunions (22 femora, 28 tibiae, 13 humeri, 5 radii, and 1 ulna) were treated with extracorporeal shock waves. The technical parameters were 6,000 to 10,000 impulses at 28 kV (0.62 mJ/mm 2 energy flux density) for the femur and tibia, 4,000 impulses at 24 kV for the humerus (0.56 mJ/mm 2 energy flux density), and 3,000 impulses at 24 kV (0.56 mJ/mm 2 energy flux density) for the radius and ulna. Sixty-six patients were followed up. The total successful rate of bony union was 75.4%. ESWT was successful in hypertrophic nonunions and seemed to have no evident effect in atrophic nonunions. We believe that extracorporeal shock wave therapy may be a good choice for nonunions of long bone fracture especially in hypertrophic nonunions.Résumé L'objectif de cette étude a été d'évaluer cliniquement les résultats observés sur les 7 dernières années lde a technique extracorporelle "schock wave" (ESWT) sur le traitement des pseudarthroses des os longs. Matériel et méthode : 69 patients présentant 69 pseudarthroses (22 fémurs, 28 tibias, 13 humérus, 5 radius et 1 cubitus) ont été traités selon cette méthode. Les paramètres techniques étaient de 6000 et de 10000 impulsions à 28 kV (062 mJ/mm2) pour le fémur et le tibia, 4000 impulsions à 24 kV pour l'humérus (0.56 mJ/mm2), 3000 impulsions à 24 kV (0.56 mJ/mm2) pour le radius et le cubitus. Résultats : 66 patients ont été suivis pendant au moins 12 mois. Le taux de consolidation a été de 75,4%. La ESWT est une technique qui permet de traiter une pseudarthrose hypertrophique alors qu'elle a peu d'effet sur les pseudarthroses atrophique. Conclusion : nous pensons que cette technique est une technique de choix pour les pseudarthroses des os longs spécialement lorsque ces pseudarthroses sont hypertrophiques.

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

“…If these six patients were included in the study as not healed, we would still have achieved a high healing rate of 79.3%, matching the results of surgical intervention. Previously published studies using ESWT in nonunions, achieved a healing rate ranging from 52% to 91% [2,26,28,56,57]. We have also recently shown that ESWT is a feasible method to treat tibial non-unions as complete healing was evident in 80.2% (138/172 non-unions) [2].…”

Extracorporeal shockwave therapy (ESWT) – First choice treatment of fracture non-unions?

“…A C C E P T E D ACCEPTED MANUSCRIPT 9 Currently, there are more than 20 peer reviewed publications available reporting about the use of ESWT in bone healing disturbances (in addition to already cited articles [24][25][26][27][28][29][30]). All these publications including the review of Zelle et al [31] comparably show significant healing rates of fracture non-unions with practically no appreciable side effects.…”

Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures

“…Previous studies have reported that the effect of ESWT is comparable to surgery for femoral hypertrophic non-unions [8]. In the case of femoral atrophic non-unions, as reported in several small clinical studies, the success rate of ESWT was not as good as for hypertrophic non-unions, and the use of ESWT for atrophic non-unions was considered controversial [7,9,10]. Furthermore, little is known on the outcomes of subsequent surgeries needed after ESWT did not achieve bony union and whether the ESWT produces any negative impacts on these surgeries.…”