Tomasz Bara1, Marek Synder. 1. Katedra i Klinika Ortopedii i Ortopedii Dzieciecej Uniwersytetu Medycznego, Łódź. tomasz.bara@neostrada.pl
Abstract
BACKGROUND: Stimulation of bony union by means of various physical modalities has not been widely used in clinical practice. Extracorporeal shock wave therapy (ESWT) offers the most promise. ESWT was first used to crush kidney stones (lithotripsy) in 1980. It is based on a sound rationale. Shock waves penetrate soft tissues and to release mechanical energy at the surface of bone, producing microfractures in sclerotic bone ends and triggering physiologic fracture healing, or "healing of fracture without a fracture". MATERIAL AND METHODS: Since 1998 we have treated more than 150 patients with delayed and non-unions of fractures using a standard lithotripter. Between 1,500 and 3,000 pulses were generated during one procedure depending on fracture size. Treatment effects were typically seen in the first follow-up radiographs at 6-12 weeks. RESULTS: Fracture union was achieved in 83% of the patients after 3-6 months. No complications were noted. The method arguably represents a useful adjunct to the treatment of bone union disturbances. It is a method of choice for patients with non-dislocated bony fragments. It can be used with metal implants or immobilisation in a cast or brace. In patients with dislocated bony fragments, we used the Ilizarov apparatus for correction and compression and shock waves for stimulation of healing. The best results were observed in delayed unions and vital nonunions. Atrophic nonunions did not respond well. Large bone defects did not fill. CONCLUSIONS: Shock wave therapy is a very effective treatment for delayed union or non-union of bone. It is a safe and complication-free method. ESWT should be considered in every case of delayed union. It may help avoid surgery under favourable conditions.
BACKGROUND: Stimulation of bony union by means of various physical modalities has not been widely used in clinical practice. Extracorporeal shock wave therapy (ESWT) offers the most promise. ESWT was first used to crush kidney stones (lithotripsy) in 1980. It is based on a sound rationale. Shock waves penetrate soft tissues and to release mechanical energy at the surface of bone, producing microfractures in sclerotic bone ends and triggering physiologic fracture healing, or "healing of fracture without a fracture". MATERIAL AND METHODS: Since 1998 we have treated more than 150 patients with delayed and non-unions of fractures using a standard lithotripter. Between 1,500 and 3,000 pulses were generated during one procedure depending on fracture size. Treatment effects were typically seen in the first follow-up radiographs at 6-12 weeks. RESULTS:Fracture union was achieved in 83% of the patients after 3-6 months. No complications were noted. The method arguably represents a useful adjunct to the treatment of bone union disturbances. It is a method of choice for patients with non-dislocated bony fragments. It can be used with metal implants or immobilisation in a cast or brace. In patients with dislocated bony fragments, we used the Ilizarov apparatus for correction and compression and shock waves for stimulation of healing. The best results were observed in delayed unions and vital nonunions. Atrophic nonunions did not respond well. Large bone defects did not fill. CONCLUSIONS: Shock wave therapy is a very effective treatment for delayed union or non-union of bone. It is a safe and complication-free method. ESWT should be considered in every case of delayed union. It may help avoid surgery under favourable conditions.