title: Extracorporeal shock waves in the treatment of nonunions.
abstract: BACKGROUND
  Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of nonunions. To date, no prospective, randomized trial has been conducted to show the efficacy of this form of treatment.
  
  
  METHODS
  This study was performed to determine the value of extracorporeal shock wave therapy for nonunions. Previous published results in the literature and our own clinical results were analyzed and related to the natural history of bony union.
  
  
  RESULTS
  No study has proven that extracorporeal shock wave therapy improves bone healing. Clinical studies reporting the acceleration of union after application of shock waves instead seem to misinterpret the natural history of bony union.
  
  
  CONCLUSIONS
  No evidence supports the treatment of pseudarthroses with extracorporeal shock waves. A randomized, prospective, clinical trial with a control group has to be performed before a final decision can be made regarding this indication for extracorporeal shock wave therapy.
authors.affiliation: Department of Orthopedics, University of Innsbruck, Austria. rainer.biedermann@uibk.ac.at
authors.forename: Rainer
authors.initials: R
authors.lastname: Biedermann
authors.forename: Arho
authors.initials: A
authors.lastname: Martin
authors.forename: Gerhart
authors.initials: G
authors.lastname: Handle
authors.forename: Thomas
authors.initials: T
authors.lastname: Auckenthaler
authors.forename: Christian
authors.initials: C
authors.lastname: Bach
authors.forename: Martin
authors.initials: M
authors.lastname: Krismer
mesh_terms: D000328:Adult; D000818:Animals; D018450:Disease Progression; D005260:Female; D005599:Fractures, Ununited / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016896:Treatment Outcome