[Intraoperative Shock-Wave Application in Scaphoid Reconstruction with Non-Vascularised Bone Grafts: A Randomised...

Focused high-energy extracorporeal shock-wave therapy (ESWT) promotes bone healing through neo-angiogenesis, pooling of stem cells, and activation of osteocytes. This study investigated whether additional intraoperative ESWT improves or accelerates the healing rate of scaphoid reconstruction with non-vascularised bone grafts in cases of pseudarthrosis.This randomised, controlled study included 93 patients who underwent scaphoid reconstruction with a non-vascularised bone graft (radius cancellous bone, iliac crest cancellous bone, or iliac crest corticocancellous graft). The patients were divided into two groups: an intervention group that received intraoperative ESWT in addition to the reconstruction, and a control group that received sole reconstruction. Healing rates as well as the percentage of osseous bridging between the scaphoid and the bone graft were evaluated and compared clinically and radiologically at 12, 18, and 24 weeks postoperatively.After 24 weeks, 80% of the scaphoids (37 of 46) in the intervention group had healed, compared with 66% (31 of 47) in the control group. Healing rates in the proximal third of the scaphoid were 77% in the intervention group and 76% in the control group. In the middle third, healing rates were 82% and 57%, respectively. All pseudarthroses of the distal third healed. After 12 weeks, the percentage of osseous bridging of the scaphoid distal to the graft was significantly higher in the intervention group (87% versus 80%), but not proximal to the graft.A single intraoperative ESWT improves the healing rate of scaphoid reconstruction with a non-vascularised bone graft and accelerates bone healing during the first 12 postoperative weeks.