There is little information in the pertinent literature. The application in the clinical practice is controversial because the effect is difficult to be precisely assessed.
Dear Panayot
I have few cases (five) in which shock wave therapy was indicated. Four pseudoartrhosis healed. All cases had previously been operated (absolute stability). All five patients had had surgical treatment of the initial fracture, consisting plate fixation (absolute stability). The indication for shock-wave therapy was for those pseudoartrhosis when, at least one surgical surgical procedure was used and union was not obtained. Three extracorporeal shock-wave therapy sessions were performed at three-week intervals. I suggest reading the article:
Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions. Cacchio A. et al.J Bone Joint Surg Am, 2009 Nov 01;91(11):2589-2597
Thank you, Nelson.
Anyway, I wonder why this method is not very popular. In the pertinent literature there are very optimistic and encouraging results. To my best knowledge the first clinical application of shock wave therapy (SW) was done and published by Valchanov and Mihailov (Int. Orthop. 1991,151,181-4). They present a 85% successful rate in delayed and non-unions of fractures. After that there are a number of publications (experimental and clinical) which confirm the stimulative effect of SW-therapy mainly in hypertrophic pseudoarhoses (Wang et al., Haupt et al., Johannes et al ,etc). I wonder why this positive effect is not the same in hypotrophic or atrophic non-unions ? And secondly, why SW-therapy is not used as a first line therapy in appropriate cases ? Obviously, the complex mechanism of action, dosage and timing of sessions need more research.
Dear Panayot
The first question needs more research but I believe the problem is more biological and the 2nd question, particularly in Brazil, the cost is very high - each session costs USD 1.300
Dear Panayot,
we are using ESWT for non-unions since 1998 on a regular base in the AUVA-Trauma Center Meidling in Vienna, Austria. We treated more than 3500 patients with an overall healing rate of ~ 80%. We did not see significant differences in the outcame between atrophic and oligotrophic non-unions. As we use an electrohydraulic device we apply ESWT in a single session. We save almost 70% of the costs compared to surgery. In Austria ESWT is the therapy of first choice for non-unions.
Regards
Wolfgang
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