Shock wave nonunion therapy (ESWT) comparable to surgery in hypertrophic nonunions

Six months after both treatments, radiographic and clinical healing occurred in about 70% of patients. - By Susan M. Rapp

ORTHOPAEDICS TODAY EUROPE 2010; 13:14Extracorporeal shock wave therapy (ESWT)
- provides pain relief
- effective as surgery in resolving hypertrophic nonunions of the femur, tibia and radius.
- noninvasive treatment that focuses pulsed shock waves on targeted areas.
- promote healing by improving the vascularity of tissue and blood supplies.
- "orthopaedic surgeons and their patients now have more options to help repair a fracture that does not respond to initial treatment.”

Healing of various types of nonunion fractures with extracorporeal shock wave therapy was found comparable to surgical results 6 months after both treatments. Images: Cacchio A

-In study of 126  patients with femoral, tibial or radial nonunions into three groups.
- 1st two groups’ nonunions were treated with ESWT therapy in four sessions, 1 week apart, which each focused 4,000 ESWT impulses on the nonunion site.

-  in group 3 patients received intramedullary nailing, plate fixation or the two combined for their nonunions.

- Based on radiographic and clinical outcomes, the rate of healing within 6 months of treatment was 70%, 71% and 73% in groups 1, 2 and 3, respectively.

- patients examined at 12 and 24 months (after treatment), there were no significant differences in terms of healing. Scans of the bones proved noninvasive shock wave therapy worked just as effectively as surgery”.

Nonunion persisted for 12 months after this 64-year-old woman’s right humerus fracture was fixed surgically.

A fracture callus is evident in this X-ray of the humerus 6 months after extracorporeal shock wave treatment.

- cases, such as atrophic nonunions or malaligned fractures, where using shock waves may not be as effective.

For more information: Angelo Cacchio, MD, can be reached in the Department of Physical Medicine and Rehabilitation, San Salvatore Hospital of L’Aquila, via L. Natali 1, 67100 L’Aquila, Italy; +39-862-607235; e-mail: angelo.cacchio@tin.it. He has no direct financial interest in any products or companies mentioned in this article.
J. Lawrence Marsh, MD, can be reached at the Department of Orthopaedics, 200 Hawkins Drive, Suite 1181RC, Iowa City, IA 52242-1088 U.S.A. ; e-mail: j-marsh@uiowa.edu. He has no direct financial interest in any products or companies mentioned in this article.

• Reference:

Cacchio A, Giordano L, Colafarina O, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg (Am). 2009;91:2589-2597.