Effects of extracorporeal shock wave therapy on fracture nonunions.
The purpose of this study was to examine the effect of focused extracorporeal shock wave therapy (ESWT) on the treatment of nonunions. As part of a prospective study, we included 143 patients (average age, 41.4 years) with a diagnosis of nonunion (mean, 14.1 months; range, 6-84 months). High-energy shock wave treatment was applied using shock wave generator. The shock waves were applied in 3-5 sessions of 2500 to 3000 impulses each given at 0.25-0.84 mJ/mm(2), at intervals of 48-72 hours between sessions. A maximum of 3 cycles of treatment was given, at 3-month intervals. The patients were followed during a 12-month period until fracture healing or, in case of failure, until another therapy was adopted. Complete healing was observed in 80 of 143 cases (55.9%) at an average time of 7.6 months (range 2-24 months). Partial healing occurred in 41 cases (28.7%) and no healing was observed in 22 cases (15.4%). Patients with trophic nonunions had a better success rate than patients with atrophic nonunions (P<.05). The results show extracorporeal shock wave therapy is a safe and effective treatment for nonunion. ESWT is more effective for trophic nonunions than atrophic nonunions.
Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, La Sapienza University School of Medicine, Rome, Italy. mariachiara.vulpiani@gmail.com
Maria C
MC
Vulpiani
Mario
M
Vetrano
Federica
F
Conforti
Lucia
L
Minutolo
Donatella
D
Trischitta
John P
JP
Furia
Andrea
A
Ferretti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017102:Fracture Healing / Q000528:radiation effects*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult