title: Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions.
abstract: BACKGROUND
  The authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions.
  
  
  METHODS
  One hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm(2) (Group 1) or 0.70 mJ/mm(2) (Group 2). The patients in the three groups had similar demographic characteristics, durations of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment.
  
  
  RESULTS
  The radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months.
  
  
  CONCLUSIONS
  Extracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hypertrophic nonunions and yields better short-term clinical outcomes.
authors.affiliation: Department of Physical Medicine and Rehabilitation, San Salvatore Hospital of L'Aquila, via L. Natali 1, 67100 L'Aquila, Italy. angelo.cacchio@tin.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Cacchio
authors.forename: Lucio
authors.initials: L
authors.lastname: Giordano
authors.forename: Olivo
authors.initials: O
authors.lastname: Colafarina
authors.forename: Jan D
authors.initials: JD
authors.lastname: Rompe
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tavernese
authors.forename: Francesco
authors.initials: F
authors.lastname: Ioppolo
authors.forename: Stefano
authors.initials: S
authors.lastname: Flamini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Spacca
authors.forename: Valter
authors.initials: V
authors.lastname: Santilli
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005264:Femoral Fractures / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005599:Fractures, Ununited / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006984:Hypertrophy; D008096:Lithotripsy; D008297:Male; D019637:Orthopedic Procedures; D011446:Prospective Studies; D011885:Radius Fractures / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D013978:Tibial Fractures / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D014458:Ulna Fractures / Q000473:pathology* / Q000601:surgery / Q000628:therapy*