Abstract
Although extracorporeal shock-wave therapy (ESWT)1 has been used extensively for treatment of nonunions of bone fractures (1), this treatment fails in many patients. Plain radiography remains the gold-standard approach for monitoring nonunion healing. Biochemical bone markers, however, may provide information regarding the effects of treatment earlier than radiography. Osteocalcin (OC) and bone-specific alkaline phosphatase (bALP) are used to monitor normal and delayed fracture healing (2). We investigated whether these biochemical bone markers can be used to distinguish between nonunions that respond to ESWT treatment and those that do not and to provide this information earlier than radiographic findings. Study participants were 34 patients [26 men and 8 women, mean (SD) age 42.5 (5.9) years] with tibial (22 patients) or femoral (12 patients) hypertrophic nonunions. This study was approved by our local ethics committee, and all subjects gave their written informed consent. All the patients underwent the same ESWT treatment, which consisted of 4 separate ESWT sessions at 1-week intervals, with 4000 impulses per session with an energy-flux density (EFD) of 0.40 mJ/mm2, provided by a an electromagnetic ESWT generator (Modulith SLK Storz Medical AG). The nonunion healing process was assessed …
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