Nigh-energy extracorporeal shock wave treatment of nonunions

Forty-three consecutive patients who did not have healing of tibial or femo ral diaphyseal and metaphyseal fractures and osteotomies for at least 9 mon ths after injury or surgery were examined prospectively for use of high-ene rgy extracorporeal shock waves. Former treatment modalities (cast, external fixator, plate osteosynthesis, limitation of weightbearing) remained uncha nged. In all cases a (99m)Technetium dicarboxyphosphonate regional two-phas e bone scintigraphy was performed before one treatment with 3000 impulses o f an energy flux density of 0.6 mJ/mm(2). Radiologic and clinical followups were done at 4-week intervals starting 8 weeks after shock wave treatment. The success criterion was bridging of all four cortices in the anteroposte rior and lateral radiographic views, in oblique views, or by conventional t omography, An independent observer described bony consolidation in 31 of 43 cases (72%) after an average of 4 months (range, 2-7 months). Twenty-nine of 35 (82.9%) patients with a positive bone scan had healing of the pseudar throsis compared with two of eight (25%) patients with a negative bone scan . Six of these eight patients with negative scans were heavy smokers. No co mplications were observed. High-energy shock wave therapy seemed to be an e ffective noninvasive tool for stimulation of bone healing in properly selec ted patients with a diaphyseal or metaphyseal nonunion of the femur or tibi a, Additional controlled studies are mandatory.