Abstract
BackgroundA substantial body of evidence supports the use of focused extracorporeal shock wave therapy (fESWT) in the non-invasive treatment of fracture nonunions. On the other hand, virtually no studies exist on the use of radial extracorporeal shock wave therapy (rESWT) for this indication.MethodsWe retrospectively analyzed 22 patients treated with rESWT for fracture nonunions of superficial bones that failed to heal despite initial surgical fixation in most cases. Radial extracorporeal shock wave therapy was applied without anesthesia in three rESWT sessions on average, with one rESWT session per week and 3000 radial extracorporeal shock waves at an energy flux density of 0.18 mJ/mm2 per session. Treatment success was monitored with radiographs and clinical examinations.ResultsSix months after rESWT radiographic union was confirmed in 16 out of 22 patients (73%), which is similar to the success rate achieved in comparable studies using fESWT. There were no side effects. The tibia was the most common treatment site (10/22) and 70% of tibia nonunions healed within 6 months after rESWT. Overall, successfully treated patients showed a mean time interval of 8.8 ± 0.8 (mean ± standard error of the mean) months between initial fracture and commencement of rESWT whereas in unsuccessfully treated patients the mean interval was 26.0 ± 10.1 months (p < 0.05). In unsuccessful tibia cases, the mean interval was 43.3 ± 13.9 months.ConclusionsRadial extracorporeal shock wave therapy appears to be an effective and safe alternative in the management of fracture nonunions of superficial bones if diagnosed early and no fESWT device is available. The promising preliminary results of the present case series should encourage the implementation of randomized controlled trials for the early use of rESWT in fracture nonunions.
Highlights
A substantial body of evidence supports the use of focused extracorporeal shock wave therapy in the non-invasive treatment of fracture nonunions
There was a statistically significant difference between Groups radial extracorporeal shock wave therapy (rESWT)+ and rESWT− with respect to the time interval between initial trauma and first application of rESWT: in the group with positive clinical outcome this time interval was 8.8 ± 0.8 months whereas in the group with negative clinical outcome on average 26.0 ± 10.1 months had passed between bone fracture and rESWT commencement (p = 0.010) (Fig. 1c)
Radial extracorporeal shock waves can reach superficial bones, and the results of the present study suggest that rESWT is a safe and effective treatment for fracture nonunions of superficial bones. (ii) For both radial extracorporeal shock waves (rESWs) and fESWs, new bone formation was demonstrated in animal models in vivo [52, 62]. (iii)
Summary
A substantial body of evidence supports the use of focused extracorporeal shock wave therapy (fESWT) in the non-invasive treatment of fracture nonunions. Full list of author information is available at the end of the article fracture stabilization using bone grafts and internal/external fixation has remained the gold standard for treating fracture nonunions. These procedures often lead to serious complications including deep infections, persistent wound drainage, hematoma formation, sensory loss, persisting pain, and nonunions [2, 4,5,6]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
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