Extracorporeal Shock Wave Application in the Treatment of Pseudarthrosis

Abstract

Approximately 5% of all bone fractures are complicated by the development of a pseudarthrosis, i. e., a delay in fracture healing of more than 6 months. Pseudarthroses can be caused by several reasons, such as inappropriate vascular supply, improper immobilization, or a large distance between the ends of the bone fragments. In cases of aseptic pseudarthroses, surgical intervention is the current state-of-the-art therapy, with the aim of healing the pseudarthrosis itself and correcting false positions of bone fragments and differences in the lengths of the extremities. About 10 years ago, extracorporeal shock wave administration was introduced into the treatment of pseudarthroses. Interestingly, the current use of extracorporeal shock waves with high energy in the treatment of pseudarthroses is based on the unproven assumption that the induction of microfissures and bone fragments is necessary for healing. Furthermore, the studies published so far are very heterogeneous with respect to inclusion and exclusion criteria of the patients, type and localization of the pseudarthroses, therapeutic design, and follow-up strategies. Based on the results of these studies, which are critically reviewed here, one can conclude the following: (I) hypertrophic pseudarthroses seem to be better targets for extracorporeal shock wave application than atrophic ones (II) altogether, treatment of pseudarthroses with extracorporeal shock waves results in rates of bony union of approximately 75%, but the real value of this data is yet to be confirmed by controlled prospective studies (III) the clinical studies carried out so far do not seem to set the proper framework for randomized, placebo-controlled studies.