Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis

Sansone, Valerio; Ravier, Domenico; Pascale, Valerio; Applefield, Rachel C.; Fabbro, Massimo Del; Martinelli, Nicolò

doi:10.3390/jcm11071977

Cited by 8 publications

(7 citation statements)

References 59 publications

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“…A variety of bone and muscle diseases have been treated with ESWT, including external epicondylitis of the humerus, plantar fasciitis, bone nonunion. [29][30][31] Recently, ESWT have been investigated, but the mechanisms of action are not well understood. According to general knowledge, extracorporeal shock waves induce characteristic changes within living tissues due to the conversion of mechanical signals into biochemical signals.…”

Section: Implication and Explanation Of Findingsmentioning

confidence: 99%

Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis

Xiao

Chen

et al. 2022

Medicine

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Background: Extracorporeal shock wave therapy (ESWT) is a relatively new type of treatment for many musculoskeletal disorders. However, ESWT for low back pain remains controversial as the pain relieve benefit is questionable. We performed this systematic review and meta-analysis to explore the effectiveness and safety of ESWT interventions on pain and disability in patients with low back pain (LBP). Methods: In this meta-analysis, we searched electronic databases in the Pubmed, Embase, Cochrane’s library, China National Knowledge Infrastructure, and Wanfang Database to determine the equivalence of ESWT and placebo for the treatment of LBP up to April 4, 2022. A number of other outcomes were measured, including functional status, quality of life, and psychological outcomes measured by the Oswestry Disability Index. Weighted mean differences were calculated for continuous outcomes, while risk ratios were calculated for binary outcomes. Stata 12.0 software was used for statistical analysis. Results: Thirteen randomized controlled trials included for further analysis. Compared with control, the ESWT group showed lower pain intensity at month 1 ( P < .05), as well as lower disability score at month 1 ( P < .05) and at month 3 ( P < .05). There was no statistically significant difference between ESWT and control groups in terms of the pain intensity at month 3 ( P > .05). No serious adverse events related to treatment were reported. Sensitivity analysis demonstrates that the conclusions from this analysis were robust. Conclusions: ESWT is effective in alleviating pain and improving the functional outcomes for patients with LBP. However, there remains a lack of high-level evidence to verify their effectiveness and safety and support their clinical application.

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Section: Implication and Explanation Of Findingsmentioning

confidence: 99%

Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis

Xiao

Chen

et al. 2022

Medicine

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“…Within this frame, the use of ESWT has gathered increasing attention due to its biological potential in enhancing osteogenesis ( 12 , 13 ) and thus promoting fracture healing ( 5 , 7 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…Increasing evidence in basic research demonstrates that shock wave stimulation generates its effect in tissue via mechanotransduction which triggers several endogenous bone regeneration processes via cell proliferation, differentiation, and migration ( 15 – 17 ). Furthermore, there are several clinical observational studies on the beneficial effects of ESWT on bone healing ( 7 , 13 , 14 , 18 , 19 ). For instance, a very recent systematic review of the literature conducted on three main databases (i.e., PubMed, Scopus, and Web of Science) showed that out of 1200 total long bone nonunions, 876 (73%) healed after being treated with ESWT, with hypertrophic cases achieving 3-fold higher healing rates when compared to oligotrophic or atrophic cases ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, there are several clinical observational studies on the beneficial effects of ESWT on bone healing ( 7 , 13 , 14 , 18 , 19 ). For instance, a very recent systematic review of the literature conducted on three main databases (i.e., PubMed, Scopus, and Web of Science) showed that out of 1200 total long bone nonunions, 876 (73%) healed after being treated with ESWT, with hypertrophic cases achieving 3-fold higher healing rates when compared to oligotrophic or atrophic cases ( 14 ). Again, another recent retrospective study reported positive outcomes, defined by radiographic bone consolidation 6-month follow-up and absence of both pain and functional limitations during normal weight loading, in 16 out of 22 (73%) patients treated with rESWT for fracture nonunions that failed to heal despite initial surgical fixation ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Treatment of delayed union of the forearm with extracorporeal shockwave therapy: a case report and literature review

Ryskalin,

Fulceri,

Morucci

et al. 2023

Front. Endocrinol.

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Compared to other long bones, forearm fractures are particularly challenging due to the high rate of complications. These include malunion, delayed/nonunion, wrist and elbow movement reduction, and pain. Surgical procedure is considered the gold standard for managing delayed union and nonunion of the long bones. However, in the last decades, extracorporeal shockwave therapy (ESWT) has emerged as an effective and less invasive approach to enhance bone regeneration and fracture healing, avoiding major complications of surgical procedures. In contrast to the broad literature reporting good clinical results of ESWT in the treatment of nonunions, there is currently limited evidence regarding the clinical application of shock waves on long bone delayed fractures, particularly those of the forearm. In the present paper, we report a case of delayed bone healing of the diaphyseal region of the ulna treated with focused ESWT. The successful case experienced bone healing at the fracture site in less than 3 months after initial ESWT treatment. Acknowledging the limitation of reporting a case report, however, the remarkable clinical results and the absence of side effects contribute valuable information in support of the use of ESWT as an effective alternative to standard surgery for forearm fractures.

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“…Numerous techniques have been proposed for the treatment of femoral shaft pseudarthrosis, including electromagnetic fields [7], low-intensity ultrasound [8], extracorporeal shock wave therapy (ESWT) [9], external fixators [10] and osteosynthesis with plate and screws [11]. Moreover, several studies have reported positive results after the treatment of non-union of the femur with single or double plate fixation combined with autologous bone graft [12,13].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Femoral Shaft Pseudarthrosis, Case Series and Medico-Legal Implications

Basile

Fozzato

Petrucci

et al. 2022

JCM

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Pseudarthrosis (PSA) is a possible complication of femoral shaft fracture treatment. It is often associated with reduced bone quality and can, therefore, adversely affect quality of life. Its treatment poses a major challenge for orthopaedic surgeons. Several authors have set forth different surgical approaches for the treatment of pseudarthrosis, such as internal fixation with plate and screws, replacement of an intramedullary nail or prosthetic replacement. In cases associated with bone loss, osteopenia, or comminution of fracture fragments, autologous or homologous bone grafts may also be used. The chronic outcomes of the surgical treatment of femoral shaft pseudarthrosis, even when consolidation is achieved, are linked to disabling sequelae of clinical-functional relevance, deserving an adequate medico-legal evaluation. The purpose of this retrospective study is to analyse a clinical case series of patients treated for atrophic femoral shaft pseudarthrosis at the IRCCS Orthopaedic Institute Galeazzi, Milan, Italy, from 2014 to 2020 and their orthopaedic-traumatological and medico-legal implications.

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Extracorporeal Shockwave Therapy in the Treatment of Nonunion in Long Bones: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 59 publications

Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis

Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis

Treatment of delayed union of the forearm with extracorporeal shockwave therapy: a case report and literature review

Treatment of Femoral Shaft Pseudarthrosis, Case Series and Medico-Legal Implications

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