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[Intraoperative Shock-Wave Application in Scaphoid Reconstruction with Non-Vascularised Bone Grafts: A Randomised
Marion Mühldorfer-Fodor1,2, Matthias Wagner3, Tanja Kottmann4
1Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Germany.
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|October 22, 2025
Summary
Adding focused high-energy extracorporeal shock-wave therapy (ESWT) to scaphoid reconstruction with bone grafts significantly improved bone healing rates and accelerated osseous bridging, particularly in the middle third of the scaphoid.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Scaphoid pseudarthrosis often requires surgical reconstruction using non-vascularized bone grafts.
- Bone healing is a complex process involving angiogenesis, stem cell activity, and osteocyte function.
- Extracorporeal shock-wave therapy (ESWT) has demonstrated potential in enhancing bone healing.
Purpose of the Study:
- To evaluate the efficacy of intraoperative focused high-energy extracorporeal shock-wave therapy (ESWT) in improving scaphoid reconstruction outcomes.
- To determine if ESWT accelerates the healing rate and osseous bridging in scaphoid non-unions treated with bone grafts.
- To compare healing rates between patients receiving standard reconstruction versus those receiving additional intraoperative ESWT.
Main Methods:
- A randomized controlled study involving 93 patients undergoing scaphoid reconstruction with non-vascularized bone grafts.
- Patients were allocated to either an intervention group (reconstruction + intraoperative ESWT) or a control group (reconstruction only).
- Clinical and radiological assessments of healing rates and osseous bridging were performed at 12, 18, and 24 weeks postoperatively.
Main Results:
- After 24 weeks, 80% of scaphoids healed in the intervention group versus 66% in the control group.
- Significantly higher healing rates were observed in the middle third of the scaphoid in the ESWT group (82% vs. 57%).
- Enhanced osseous bridging distal to the graft was noted at 12 weeks in the intervention group (87% vs. 80%).
Conclusions:
- Intraoperative focused high-energy ESWT significantly improves the overall healing rate of scaphoid reconstructions utilizing non-vascularized bone grafts.
- ESWT demonstrates an acceleration of bone healing, particularly evident within the first 12 postoperative weeks.
- The addition of ESWT is a promising adjunctive therapy for scaphoid non-union reconstruction.
