Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions

• Published in: Journal of bone and joint surgery. American volume 2009-11, Vol.91 (11), p.2589-2597
• Main Authors: Cacchio, Angelo, Giordano, Lucio, Colafarina, Olivo, Rompe, Jan D, Tavernese, Emanuela, Ioppolo, Francesco, Flamini, Stefano, Spacca, Giorgio, Santilli, Valter
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Diseases of the osteoarticular system; Double-Blind Method; Female; Femoral Fractures - pathology; Femoral Fractures - surgery; Femoral Fractures - therapy; Fractures, Ununited - pathology; Fractures, Ununited - surgery; Fractures, Ununited - therapy; Humans; Hypertrophy; Injuries of the limb. Injuries of the spine; Lithotripsy; Male; Medical sciences; Orthopedic Procedures; Prospective Studies; Radius Fractures - pathology; Radius Fractures - surgery; Radius Fractures - therapy; Tibial Fractures - pathology; Tibial Fractures - surgery; Tibial Fractures - therapy; Traumas. Diseases due to physical agents; Ulna Fractures - pathology; Ulna Fractures - surgery; Ulna Fractures - therapy
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.H.00841

BackgroundThe authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions.MethodsOne hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm (Group 1) or 0.70 mJ/mm (Group 2). The patients in the three groups had similar demographic characteristics, durations of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment.ResultsThe radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months.ConclusionsExtracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hypertrophic nonunions and yields better short-term clinical outcomes.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.