Shockwave Therapy of Fracture Nonunion
Shockwave therapy has emerged as a promising non-invasive treatment for fracture nonunion, a condition where bones fail to heal properly. This innovative approach utilizes acoustic waves to stimulate the natural healing process, promoting cellular activity and blood flow to the affected area. By encouraging bone regeneration and enhancing tissue repair, shockwave therapy offers a potential alternative to surgery or prolonged immobilization. This part will explore the effectiveness and potential benefits of shockwave therapy in addressing fracture nonunion, providing new hope for patients with challenging healing cases.
What is fracture nonunion?
Fracture nonunion refers to a complication that occurs when a broken bone fails to heal properly despite an extended period of time. In this condition, the normal bone healing process is disrupted, leading to a persistent gap or lack of progression in bone union. Various factors can contribute to nonunion, such as poor blood supply, infection, inadequate immobilization, or patient-related issues like smoking or certain medical conditions.
What are the symptoms of fracture nonunion?
Persistent pain at the fracture site, which may worsen with activity.
Limited range of motion and difficulty using the affected limb.
Tenderness and swelling around the fractured area.
A visible gap or lack of progress in bone healing on X-ray images.
Instability and abnormal mobility at the fracture site.
Inability to bear weight or perform normal activities without discomfort.
The fracture site may feel abnormally warm or show signs of localized inflammation.
The fracture may remain tender to touch long after the expected healing period.
Fracture-related symptoms persist beyond the usual healing period, usually around 6-9 months after the injury.
How is a nonunion fracture treated?
Surgical Intervention: Bone grafting, internal fixation with screws or plates, or the use of bone stimulators to promote healing.
Electrical Stimulation: Application of low-level electrical currents to enhance bone healing.
Pulsed Electromagnetic Field (PEMF) Therapy: The use of electromagnetic fields to aid bone healing.
Medications: Use of certain medications to improve bone healing and reduce inflammation.
Physical Therapy: Targeted exercises and therapies to improve circulation and mobility around the fracture site.
Shockwave therapy for fracture nonunion
It is a non-invasive medical treatment that uses high-energy shockwaves to stimulate bone healing. The focused shockwaves target the non-healing fracture site, promoting cellular activity and blood flow to encourage tissue regeneration. This therapy triggers the body’s natural healing mechanisms, leading to improved bone union and reduced pain. Shockwave therapy offers a promising alternative for patients with stubborn fractures that have not responded to conventional treatments, providing a potential solution to promote successful bone healing without the need for surgery.
Shockwave therapy in delayed or non-healing fractures—clinical results
In the late 1990s, several authors reported successful utilization of ESWT in treating delayed or non-healing fractures. Similarly, a group of researchers in 2015 adopted ESWT as the primary treatment for non-unions and documented a case series of 115 consecutive patients who received a single session of ESWT. Within this cohort, 87 non-unions (75.7%) achieved bony healing after six months following ESWT. Moreover, they treated over 3500 delayed healing fractures and pseudarthroses at various locations, with an average success rate of nearly 80% after six months of follow-up. Based on their experience, approximately 75% of referred patients with non-union fractures are suitable candidates for ESWT. Additionally, the significant financial benefits of ESWT compared to major surgery, with associated risks and complications, have gained recognition in healthcare systems worldwide. In Austria, treating non-union fractures with ESWT instead of surgery results in savings of around 65%-85% (depending on different assurance modalities).
“From an orthopedic perspective, the history of shockwave therapy for nonunion fractures has shown remarkable development. Clinical results have highlighted its immense impact on promoting bone healing. In my clinical experience, after 8 treatment sessions, my patient with non-healing fractures achieved complete recovery. I strongly recommend shockwave therapy for every patient with nonunion fractures. Embracing this non-invasive and effective treatment can revolutionize the management of nonunion fractures and lead to favorable outcomes for all patients. “
Scientific Support
Abstracts Worth Recommending
[1] Elster, E. A., Stojadinovic, A., Forsberg, J., Shawen, S., Andersen, R. C., & Schaden, W. (2010). Extracorporeal shock wave therapy for nonunion of the tibia. Journal of orthopaedic trauma, 24(3), 133-141.
[2] Vulpiani, M. C., Vetrano, M., Conforti, F., Minutolo, L., Trischitta, D., Furia, J. P., & Ferretti, A. (2012). Effects of extracorporeal shock wave therapy on fracture nonunions. Am J Orthop (Belle Mead NJ), 41(9), E122-7.
[3] Kertzman, P., Császár, N., Furia, J. P., & Schmitz, C. (2017). Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: a retrospective case series. Journal of orthopaedic surgery and research, 12(1), 1-10.
[4] Haffner, N., Antonic, V., Smolen, D., Slezak, P., Schaden, W., Mittermayr, R., & Stojadinovic, A. (2016). Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury, 47(7), 1506-1513.
[5] Furia, J. P., Juliano, P. J., Wade, A. M., Schaden, W., & Mittermayr, R. (2010). Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. JBJS, 92(4), 846-854.
[6] Dahm, F., Feichtinger, X., Vallant, S. M., Haffner, N., Schaden, W., Fialka, C., & Mittermayr, R. (2022). High-energy extracorporeal shockwave therapy in humeral delayed and non-unions. European Journal of Trauma and Emergency Surgery, 1-7.
[7] Willems, A., van der Jagt, O. P., & Meuffels, D. E. (2019). Extracorporeal shock wave treatment for delayed union and nonunion fractures: a systematic review. Journal of orthopaedic trauma, 33(2), 97-103.
The Scientific Research behind It
Shock Wave Therapy of Fracture Nonunion
https://www.sciencedirect.com/science/article/abs/pii/S0020138315003976
Extracorporeal Shockwave Therapy (ESWT) – First Choice Treatment of Fracture Non-unions?
https://www.sciencedirect.com/science/article/pii/S1743919115012674
Extracorporeal Shock Wave Therapy of Nonunion or Delayed Osseous Union