Shock wave therapy for long-bone nonunions comparable to surgical treatment in randomized study

Extracorporeal shock wave therapy (ESWT) provided pain relief and was as effective as surgery in resolving hypertrophic nonunions of the femur, tibia and radius, based on a study by Italian and German investigators.

ESWT is a noninvasive method of treating nonunions and other musculoskeletal conditions that focuses pulsed shock waves on areas requiring treatment. It is thought to promote healing by improving the vascularity of tissue and blood supplies.

For this study, published in the November issue of the The Journal of Bone and Joint Surgery, physiatrist Angelo Cacchio, MD, collaborated with orthopedic surgery and physical medicine colleagues in L’Aquila and Rome, Italy, and Mainz, Germany.

“These findings are important because we have found that this noninvasive therapy is a safe and simple alternative to surgery,” he stated in a press release from the American Academy of Orthopaedic Surgeons.

“This means orthopedic surgeons and their patients now have more options to help repair a fracture that does not respond to initial treatment,” Cacchio said in the release.

Cacchio and colleagues randomized 126 patients with femoral, tibial or radial nonunions into three treatment groups. All the patients’ demographics, the duration of their nonunion fractures and length of follow-up were similar.

The first two groups’ nonunions were treated with ESWT therapy. Each patient underwent four sessions, 1 week apart, which each focused 4,000 ESWT impulses on the nonunion site. The density of ESWT energy flux was 0.40 mJ/mm2 in group 1 and 0.70 mJ/mm2 in group 2.

Patients in group 3 received typical surgical treatment 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, according to the study abstract.

“Initially those who received the shock wave therapy actually felt better than those who had the surgery,” according to clinical outcomes at 3 and 6 months post-treatment, Cacchio stated in the press release.

“When we examined patients 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,” he noted.

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. Cacchio has no direct financial interest in any products or companies mentioned in this article.