Non-invasive treatment of long-bone pseudarthrosis by shock waves (ESWLR)

Abstract

Non-invasive treatment of non-union of diaphyses by application of the shock waves known from lithotripsy has proved successful in three out of four cases. Two thousand shock waves with a single-wave energy of 18 kV were applied by the MFL 5000 and HM3 Lithotripters of the Dornier Medizintechnik Company with manual detection of the lesion. The shock waves induced a kind of callus formation in the non-union soft tissue within about 6 weeks, which was successfully maintained and transformed into bony union in all cases but one by dynamic fixation less rigid than a plaster cast. Four cases are documented and the effects of the shock waves and principles of bony union discussed.

Characterization of pseudarthrosis with ultrasound backscattered signals in rats

“…Bone healing demands a perfect stability so that the capillaries could promote the revascularization crossing the fracture line and activating the transformation of pluripotential cells in osteoblasts 15,21,22 . That allows primary remodelation without periosteal callus formation.…”

“…In the rat model used, the formation of cartilaginous tissue was possible because it was found a way of maintaining the movement in the focus of the fracture with guarantee of blood supply integrity. It must be highlighted that if stability is reached naturally or even in the presence of a pseudarthrosis resulting from a fragile fixation of the fracture with monofilament threads, the calcification of the cartilage may occur and callus may be formed in a process of osteochondral repair 5,16,22 . In these cases, most of the times a vicious consolidation results, which means that the extremities can be calcified without alignment and with an axial deviation.…”

Extracorporeal shock wave treatment in nonunions of long bone fractures

“…ESWT may produce microfractures of bone [5,7], which, in turn, can stimulate neovascularisation, osteoblast formation, and bone healing. Scheberger and Senge thought ESW had a biological effect on bone derivation, which led to the bone creeping substitution of the scar between bone fracture terminals and finally led to bony healing [14]. The irritation of the fracture produces inflammatory medium and bone growth factor, which recruit bone blast cells and fibroblasts in the medullary cavity or around the parenchyma.…”

Ortopedi ve travmatolojide şok dalga tedavisi

“…İnstabilite durumunda, şok dalgası tedavisi ile birlikte eksternal immobilizasyon kullanımı gerekmektedir. [38,40,44,45] Hastada osteosentez materyali bulunması kontrendikasyon yaratmaz; ancak, intramedüller çivileme yapılmış olgularda sonuçlar, plaklı osteosentezlere göre daha başarılıdır (Şekil 1 ve 2).…”

“…Yüzeyel peteşiler, doku ödemi ve dermal erozyon, en sık bildirilen komplikasyonlardır. [36,40,45] Wang ve arkadaşları, 72 olgunun 58'inde (%80,6) yüzeyel peteşi ve 27'sinde de (%37,5) hematom oluştuğunu, fakat bunların kendiliğinden düzeldiğini bildirmiş-lerdir. [38] Minimal invaziv bir girişim olarak değerlen-dirilmesine karşın, uygulama ağrılı olduğu için rejyonel ya da genel anestezi gerekmektedir.…”