Shock wave therapy of fracture nonunion

We have used the principles of extracorporeal shock wave therapy (ESWT) in the treatment of nonunion of fractures in 44 patients (49 bones).There were 35 males and 9 females with a mean age of 34 years(range14-70). Clinical and radiological assessment was performed at regular time intervals with a minimum follow up of 18 months. Most common sites involved were the femur and tibia. The average time from initial fracture treatment to intervention with ESWT was 11.9 months (6 months to 5 years). Thirty eight non-union sites had one session of treatment and the rest (11) had more than one session. Union was successful in 75.5% of cases at a mean time of 10.2 months (range 3-19). Failure in the remaining cases was due to more than 5mm gap, instability, compromised vascularity (type of bone) and deep low grade infection; which was discovered at the time of surgical intervention when no signs of radiological healing occurred after 6 months from treatment. Failing sites were shaft of femur, scaphoid, neck of humerus and neck of femur. No local complications were observed.