Extrakorporale fokussierte Stoßwellentherapie zur Behandlung von Pseudarthrosen

Everding J, Freistühler M, Stolberg-Stolberg J, Raschke MJ, Garcia P

Abstract

BACKGROUND: Between 5and 10 % of all fractures show disturbed healing or nonunion formation. Extracorporeal shock wave therapy (ESWT) has been described as anon-surgical treatment option. Even though the outcome has shown promising results, the procedure is not commonly used in clinical practice. The purpose of this study was to analyze the union rate of pseudarthrosis and the cost savings after ESWT. METHODS: In this study 42nonunions were treated with shock waves (LithSpaceOrtho, JenaMedtech). The follow up examinations were performed over aperiod of six months. Outcome measurement included radiological fracture union and pain (VAS). The study group contained 39pseudarthrosis in the six-week follow-up (93 %), 41 after three months (98 %) and 41 after six months (98 %). RESULTS: After six weeks, 13 % of patients showed fracture union. After three months 61 % and after six months 73 % of the fractures were completely healed. The fracture healing was significantly lower in older nonunions. All patients presented significantly lower pain levels six weeks after ESWT. Shock wave treatment of all 42pseudarthrosis made up less than one quarter of the overall operative costs. CONCLUSION: We established the ESWT as an important treatment option for fracture nonunion in our clinic. Considering the selection of patients in this study with ahigh mean time from injury to ESWT and multiple prior operations, the fracture healing rate of 73 % after ESWT is comparable with operative healing rates of nonunions. Further prospective, randomized and controlled studies are needed to show the effectiveness of ESWT in the treatment of nonunions on ahigher level of evidence and to identify pseudarthrosis that particularly responds to the EWST.