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Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions
Angelo Cacchio1, Lucio Giordano, Olivo Colafarina
1Department of Physical Medicine and Rehabilitation, San Salvatore Hospital of L'Aquila, via L. Natali 1, 67100 L'Aquila, Italy. angelo.cacchio@tin.it
The Journal of Bone and Joint Surgery. American Volume
|November 4, 2009
Summary
Extracorporeal shock-wave therapy (ESWT) shows comparable radiographic healing to surgery for long-bone nonunions. ESWT offers superior short-term clinical outcomes, making it a viable alternative to surgical intervention.
Area of Science:
- Orthopedics
- Biomedical Engineering
Background:
- Long-bone nonunions present a significant clinical challenge.
- Extracorporeal shock-wave therapy (ESWT) is proposed as a non-invasive alternative to surgery.
Purpose of the Study:
- To compare the efficacy of ESWT using two devices against surgical treatment for long-bone nonunions.
- To evaluate radiographic and clinical outcomes of different treatment modalities.
Main Methods:
- 126 patients with long-bone nonunion were randomized into three groups: ESWT (two devices) and surgery.
- ESWT groups received four treatments at specific energy flux densities.
- Radiographic and clinical outcomes were assessed at multiple time points post-treatment.
Main Results:
- No significant differences in radiographic healing rates were observed among the three groups.
- ESWT groups demonstrated significantly better short-term clinical outcomes compared to surgery.
- Long-term clinical outcomes were similar across all groups, with minor differences in DASH scores at 12 months.
Conclusions:
- ESWT is as effective as surgery for promoting union in long-bone hypertrophic nonunions.
- ESWT provides superior short-term clinical results compared to surgical treatment.
