Radial versus focusing extracorporeal shock waves in treatment of delayed union and nonunion of fractures

Abstract

Objective To compare radial and focusing extracorporeal shock waves in terms of their effects on the treatment of delayed union and nonunion of fractures.Methods Forty-seven patients with delayed union or nonunion of hypertrophic stable type received extracorporeal shock wave therapy from April to August 2011.They were 38 men and 9 women,aged from 21 to 56 years (average,35.0 years).The lesions involved the femur in 24 cases,the humerus in 6 cases and the tibia in 17 cases.The primary fixations included plating in 37 cases,external fixator in 8 cases,and locking intramedullary nailing in 2 cases.Twenty-three patients received radial shock wave therapy and 24 focusing shock wave therapy.Therapies were conducted with suitable shock wave energy,frequency and dosage according to the specific fracture location.X-ray follow-ups were performed at monthly intervals to evaluate the callus growth.The 2 groups were compared in terms of the cure rate and effective rate.Results The mean follow-up was 9 months.Of the 23 patients receiving radial extracorporeal shock wave therapy,21 got complete bone union,one partial union,and one no obvious callus growth.The cure rate and effective rate were 91.3％ and 95.7％ respectively.The union time ranged from 8 to 24 weeks,averaging 12 weeks.Of the 24 patients receiving focusing treatment,17 got complete bone union and 7 no obvious callus growth.The cure rate and effective rate were both 70.8％.The union time ranged from 8 to 40 weeks,averaging 18 weeks.There was a significant difference in the effective rate between the 2 groups (P=0.048) but no regarding the cure rate (P =0.137).Radial shock wave treatment caused vascular injury in 4 cases and focusing shock wave in 9 cases.Conclusions Extracorporeal shock waves are effective treatment of delayed union and nonunion of fractures.The radial extracorporeal shock waves may be more effective than the focusing extracorporeal shock waves. Key words: High-energy shock waves; Fractures, nonunited; Delayed union; Extremities